INSTRUCTIONS FOR COMPLETING FORMS AND SUBMITTING A FINGERPRINT-BASED CRIMINAL BACKGROUND CHECK.

 

1. Go to http://www.nd.gov/dhs/services/childfamily/cbcu/child-care-index.html to access required forms.

 

1. Complete Personal Authorization for Criminal History Record Information Inquiry Form (SFN 829). Follow the instructions below for completing this form – begin at the top working your way through the form.

 

• This form must be typed. Handwritten and/or incomplete forms will not be accepted.

 

• Enter “Today’s Date” by selecting the date from the calendar drop down box – arrow will appear on right of the box.

 

• The Requesting Agency will be the ND Department of Human Services.

  • The contact person, and their contact information, will be the childcare licensor (for staff, your employer will provide you with this information)

 

• Select Child Care.

 

• Enter your employer/provider information. (for staff, your employer will provide you with this information)

 

• Enter your information in the Applicant Information section.

  • YOUR personal email address is required

  • Do not leave any sections blank.

 

• Answer questions 1-3.

  • If you answer “yes” to questions 2 or 3, you MUST provide information in the box below the questions.

 

• Address history – you must provide a full 5-year address history.

  • Begin with your current street address and work backwards.

  • Click the Add Another Address button as needed to enter additional addresses.

  • If you lived in another state in the past 5 years, you may need to complete additional authorization forms for out-of-state record requests.

    • Click on the folder for each state you have lived in during the past 5 years.

    • Read the form instructions above the form (PDF) before clicking on the form.

    • Print the completed form BEFORE signing and dating the form. Some forms require notary or witness signatures.

 

1. Complete Criminal History Record Check Request Form (SFN 60688).

 

• This form must be typed. Handwritten forms will not be accepted.

• Do not change any information that has been pre-entered into the form.

 

1. Print a BLANK Fingerprint Identity Verification Form (SFN 836).

 

1. Schedule an appointment to be fingerprinted. You must print and bring ALL forms and a valid government issued photo ID to your appointment. (School ID cards, birth certificates or social security cards are NOT acceptable.)

 

• You may also be fingerprinted at a law enforcement agency, or any other agency that is authorized to do fingerprinting.

You must mail your forms and sealed fingerprints to: NDDHS, Children & Family Services

Attn: CBCU

600 E Boulevard Ave, Dept 325

Bismarck ND 58505-0250

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Childcare Licensing Fingerprint Guidelines

 

The SFN 829 and the SFN 60866 form MUST BE TYPED – no handwritten forms will be accepted.

If you have lived in another State other than North Dakota in the last 5 Years please complete the additional State forms.

 

The forms can be found at:  http://www.nd.gov/dhs/services/childfamily/cbcu/index.html

On the SFN 829:

The Requesting Agency:  ND DHS

Contact Person: Coreen Ruona –email cruona@nd.gov

Phone Number: 701-239-6704

Address: 1010 2nd Ave S.

     P.O. Box 3106

     Fargo, ND 58108

 

Who needs to be fingerprinted?

• Providers

• Staff who do not live in the home who are 14 and older

• Household members over 18 years of age

• Emergency designee (if you chose to have one)     

 

Where to go to be fingerprinted?

Southeast Human Service Center

• Appointments only

• No Cost

• MUST BRING a valid photo ID. Ex: State ID Card, Driver’s License, etc.

Phone: 701-298-4416  

Address: 2624-9th Ave S Fargo

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