Criminal Background Checks

Licensed or Regulated Child Care Providers

List of Offenses that will restrict individuals from working in a licensed or regulated early childhood service program.

Authorization to Transfer Background Check Results - Link to form (SFN 375 Form)

Three forms are required for fingerprint-based criminal background checks for licensed or regulated child care providers. PLEASE NOTE: Not all forms are compatible with Mac programs.

INSTRUCTIONS: How to Complete Forms and Submit a Fingerprint-based Criminal Background Check

FORM 1 - Personal Authorization for Criminal History Record Information Inquiry (SFN 829) THIS FORM MUST BE TYPED.

• Additional Address History - Use as needed and attach along with SFN 829

FORM 2 - Criminal History Record Check Request Form (SFN 60688) THIS FORM MUST BE TYPED; SIGNATURE MUST BE HANDWRITTEN.

FORM 3 - Fingerprint Identity Verification (SFN 836) PRINT BLANK FORM

If you have lived outside of North Dakota during the past five years, click on each state you have lived in (below) to see if you need to:

• Complete additional out-of-state authorization forms for each state you have lived in,
• Provide a copy of a valid photo ID or a copy of your social security card, and/or
• Provide an extra set of fingerprint cards (must obtained from a law enforcement agency or an authorized third-party fingerprinting agency).

If any of the above are required, they must be mailed to the Bismarck office – Please DO NOT send anything directly to other states.

Select from the list below. PLEASE READ ALL INSTRUCTIONS CAREFULLY!

Alabama	Georgia	Maine	Nevada	Pennsylvania	Washington
Alaska	Hawaii	Maryland	New Hampshire	Rhode Island	Washington, D.C.
Arizona	Idaho	Massachusetts	New Jersey	South Carolina	West Virginia
Arkansas	Illinois	Michigan	New Mexico	South Dakota	Wisconsin
California	Indiana	Minnesota	New York	Tennessee	Wyoming
Colorado	Iowa	Mississippi	North Carolina	Texas
Connecticut	Kansas	Missouri	Ohio	Utah
Delaware	Kentucky	Montana	Oklahoma	Vermont
Florida	Louisiana	Nebraska	Oregon	Virginia

Alabama

The signature on this form below must be witnessed.

• Child Protective Services form (61kb pdf)

The signature on this form below must be witnessed by two people OR it can be notarized; an extra set of fingerprints cards are required; and a copy of a valid government issued photo ID is required.

• Criminal History Record Information form (204kb pdf)

Alaska

• Child Protective Services form (121kb pdf)
• Criminal History Record Information form (1.71mb pdf)

Arizona

• Child Protective Services form (153kb pdf)

Arkansas

Complete the form below - notary not necessary. Due to their requirements, a 2nd form will be generated by the CBCU and it will be emailed directly to you. The online generated form DOES require a notary. Mail the completed form to the CBCU. Please Do NOT mail it to Arkansas.

• Child Protective Services form (44kb pdf)

The signature on the form below must be notarized.

• Criminal History Record Information form (748kb pdf)

California

• No forms are required.

Colorado

The form below must be typed. Photo ID required.

• Child Protection Services form

Connecticut

On the form below, enter N/A in any field that does not apply to the applicant.

• Child Protective Services form (192kb pdf)

Delaware

Complete Part 1 before printing the form for signature and date. If the applicant is under the age of 18, the form below must be signed by a parent or guardian.

• Child Protective Services form (48kb pdf)

An extra set of fingerprints cards are required.

• Criminal History Record Information form (748kb pdf)

Florida

• Child Protective Services form (40kb pdf)

Georgia

• No forms are required.

Hawaii

• Child Protective Services form (24kb pdf)

Idaho

If the applicant is under the age of 18, the form below must be signed by a parent or guardian. Signature must be notarized.

• Child Protective Services form (2.61mb pdf)

Illinois

• Child Protective Services form (415kb pdf)

Indiana

• Online form required. You will receive email instructions upon the department initiating a registry search.

Iowa

• No forms are required.

Kansas

Complete the Applicant Section on the form below - NO sections can be left blank. Enter N/A if a section does not apply to the applicant.

• Child Protective Services form (1017kb pdf)

Kentucky

• Criminal History Records Request form (32kb pdf)
• Copy of valid photo ID is required.

Louisiana

The form below is only required if the applicant is 18 years old or older; requires copy of a valid photo ID.

• Child Protective Services form (1.15mb pdf)

An extra set of fingerprints cards are required.

• Criminal History Record Information form (1.20mb pdf)

Maine

Complete only if you are 18 yrs old or older. This form CANNOT BE TYPED.

• Child Protective Services form (130kb pdf)

Maryland

The form below must be typed; signature requires a notary.

• Child Protective Services form (214kb pdf)

Massachusetts

This form below requires a copy of a valid photo ID.

• Criminal History Record Information form (230kb pdf)

Michigan

A copy of a valid photo ID is required.

• Child Protective Services form

Minnesota

The signature on the form below requires a notary. If the applicant is under the age of 18, the applicant's parent or guardian will also need to sign AT THE SAME TIME IN FRONT OF NOTARY.

• Child Protective Services form (64kb pdf)

Mississippi

• Online form required. You will receive email instructions upon the department initiating a registry search.

The signature on the form below must be notarized; requires copy of valid photo ID.

• Criminal History Record Information form (48kb pdf)

Missouri

You will receive email instructions after the department receives your background check request.

Montana

The signature on the form below must be notarized. If the applicant is under the age of 18, the applicant's parent or guardian must complete the Authorization for a Minor letter. The parent or guardian signature must be notarized.

• Child Protective Services form (95kb pdf)
• Authorization for a Minor (103kb pdf)

Nebraska

The signature on the form below must be notarized. If the applicant is not 20 years old or older, the applicant's parent or guardian must sign the form.

• Child Protective Services form (168kb pdf)

The signature on the form below must be notarized.

• Criminal History Record Information form (852kb pdf)

Nevada

A copy of a valid photo ID is required.

• Child Protective Services form (76kb pdf)

New Hampshire

The signature on the form below requires a notary.

• Child Protective Services form (49kb pdf)

The signature on the form below requires a notary; self-address stamped envelope required.

• Criminal History Record Information form (451kb pdf)

New Jersey

• Child Protective Services form (90kb pdf)

New Mexico

• Child Protective Services form (234kb pdf)

The signature on the form below requires a notary.

• Criminal History Record Information form (879kb pdf)

New York

The signature on the form below requires a notary.

• Child Protective Services form (865kb pdf)

North Carolina

• No forms are required.

Ohio

• No form is required.

Oklahoma

• Child Protective Services form (173kb pdf)

Oregon

The form below must be typed.

• Child Protective Services form (837kb Word docm)

Pennsylvania

All sections of the form below must be completed. If a section does not apply to the applicant, enter N/A.

• Child Protective Services form

Rhode Island

The signature on the form below requires a notary; copy of a valid photo ID is required.

• Criminal History Record Information form (1.42mb pdf)

South Carolina

You will receive email instructions after the department receives your background check request.

South Dakota

Complete the form below ONLY if the applicant has been the subject of a child abuse/neglect report in South Dakota.

• Child Protective Services form (26kb pdf)

An extra set of fingerprints cards are required.

• Criminal History Record Information form (99kb pdf)

Tennessee

• No forms are required.

Texas

The signature on the form below requires a notary.

• Child Protective Services form (509kb pdf)

Utah

A copy of a valid photo ID is required.

• Child Protective Services form (1.17mb pdf)

An extra set of fingerprints cards are required.

• Criminal History Record Information form

Vermont

The signature on the form below requires a notary.

• Child Protective Services form (190kb pdf)

Virginia

The signature on the form below requires a notary.

• Child Protective Services form (198kb pdf)

The form below will be generated by the Criminal Background Check Unit upon receipt of your background check request. An email will be sent to the provider and the applicant with instruction on how to complete and submit the form to our office.

• Criminal History Record Information form (52kb pdf)

Washington

The form below must be typed.

• Child Protective Services form (166kb pdf)

Washington, D.C./District of Columbia

This form must be typed. Five year address history and Photo ID are required.

• Child Protective Services form (721kb pdf)

A copy of a valid photo ID is required.

• Criminal History Record Information form (26kb Word docx)

West Virginia

• Child Protective Services form

Wisconsin

This form requires a witness signature.

• Child Protective Services form

Wyoming

• Instructions will be emailed to the applicant.

Contact Information

Criminal Background Check Unit
600 East Boulevard Avenue, Department 325
Bismarck ND 58505-0250
Phone: (701) 328-7575
Toll Free: (800) 472-2622
711 (TTY)
Fax: (701) 328-0358
Email: dhscfscbc@nd.gov

 

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