utah department of health criminal background screening authorization form

\par \tab \hich\af5\dbch\af31505\loch\f5 (f) a hospice; I authorize the Utah Department of Human Services Office of Licensing to investigate and continually monitor my past and present child and adult abuse, neglect and exploitation records, law enforcement, driver license, and any information which may be pertinent to my application according to Utah Code 62A-2-120, 121, 122, and Administrative . \rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 \chftnsepc \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) over the age of 28 and has convictions or pending charges identified in R432-35-8(1)(a). \par \tab \hich\af5\dbch\af31505\loch\f5 (c) name. \par \tab \hich\af5\dbch\af31505\loch\f5 Terms used in this rule are defined in Title 26, Chapter 21\hich\af5\dbch\af31505\loch\f5 Part 2. PDF Background Check Authorization Form \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) a disabled individual, as defined by department rule; Training materials and other information related to DACS can be found here. Option 2: Send a written challenge request to the FBI. \par {\f535\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f536\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\f537\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\f869\fbidi \froman\fcharset238\fprq2 Cambria Math CE;} {\rtf1\adeflang1025\ansi\ansicpg1252\uc1\adeff5\deff0\stshfdbch31505\stshfloch31506\stshfhich31506\stshfbi31507\deflang1033\deflangfe1033\themelang1033\themelangfe0\themelangcs0{\fonttbl{\f0\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} Choose which box in the top left applies to you: If you are a new applicant with Utah Foster Care, mark the first box, If you are already licensed as a DCFS Foster Parent, or are residing in an Office of Licensing licensed foster home, mark the second box and include the licensor name, If you are working with an agency other that Utah Foster Care or DCFS, mark the third box and include the name of the agency, Legibly complete sections 1-5, filling in every box. Background Screenings for Program Staff | Division of Licensing - Utah Also located on the back of the FBI Applicant fingerprint card FD-258) Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. Fingerprint Services for the Public - DPS - Criminal Identification (BCI) \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 table of authorities;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 macro;\lsdsemihidden1 \lsdlocked0 toa heading;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List; 6d652f7468656d654d616e616765722e786d6c0ccc4d0ac3201040e17da17790d93763bb284562b2cbaebbf600439c1a41c7a0d29fdbd7e5e38337cedf14d59b Instead, the FBI accesses the states system for authorized purposes to review the record. f942f92973f5d6bbda991fd3d3878c69450034d8db08283ddd555c0f2e4fad2e0bb52b78da2261849b4d425b46377822869fc17974aad1abd0b8aeafbba54b2d \par \tab \hich\af5\dbch\af31505\loch\f5 (1) Convictions or Pending Charges \lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 5;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 5;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 5;\lsdpriority70 \lsdlocked0 Dark List Accent 5;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 5; 1-801-587-3000 A student employee moves to a non-student position. \lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 5;\lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 6;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 6;\lsdpriority48 \lsdlocked0 Grid Table 3 Accent 6; 1-888-421-1100 \par \tab \hich\af5\dbch\af31505\loch\f5 (1) Utah Code, Title 26, Chapter 21, Part 2 requires that a covered provider enter required information into the Direct Access Clearance System to initiate a clearance for each covere\hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (1) Utah Code, Title 26, Chapter 21, Part 2 requires that a covered contractor enter required information into the Di\hich\af5\dbch\af31505\loch\f5 \par PDF Information on completing background checks for Medical Cannabis - Utah For federal Identity History Summary updates, the FBI must receive a request directly from the original arresting agency, from a court with control over the arrest data, or from another agency with control over the arrest data. 13. 8f40d2f9b2d598749bdd41abd26df627956034e854bac3d6a0326a0ddba3c9681876ba9357be77a1c141bf390c5ae34ea5551f0e2b41aba6e877ba9576d068f4 \par \tab \hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (1) If the Department \hich\af5\dbch\af31505\loch\f5 {\fhimajor\f31529\fbidi \fswiss\fcharset204\fprq2 Calibri Light Cyr;}{\fhimajor\f31531\fbidi \fswiss\fcharset161\fprq2 Calibri Light Greek;}{\fhimajor\f31532\fbidi \fswiss\fcharset162\fprq2 Calibri Light Tur;} \par }{\*\themedata 504b030414000600080000002100e9de0fbfff0000001c020000130000005b436f6e74656e745f54797065735d2e786d6cac91cb4ec3301045f748fc83e52d4a National Suicide Prevention Lifeline Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background checks. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) under the age of 28; or Utah AMBER Alert and Endangered Missing Advisory. Salt Lake City, Ut 84116, DLBC Contact Info 2-35-8(1)(a), the department may deny clearance based on: \par \tab \hich\af5\dbch\af31505\loch\f5 (c) Enterta\hich\af5\dbch\af31505\loch\f5 inment groups; \par \tab \hich\af5\dbch\af31505\loch\f5 (b) where an individual who is not a resident also lives. One-time adoptions submitted by a non-licensed entity (adoption attorney, etc.) s, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to the covered provider and the individual explaining the action and the individual's right of appeal as defined in R432-30. If the background screening report reveals something that may cause you to decide not to hire the person, you must notify them of the results of the . Crisis Line & Mobile Outreach Team \par \tab \hich\af5\dbch\af31505\loch\f5 (h) a personal care agency. The screening or background check includes the submission of fingerprints for clearance on the federal data system. For example, if your disposition information is incorrect or missing, you may submit documentation obtained from the court having control over the arrest or the office prosecuting the offense. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 6; Screening agent will require a disclosure form to be signed and uploaded into DACS in order for OL to conduct continual monitoring of the RapBack criminal database and all regional and state databases as statutorily required for that applicants employment or affiliation with a licensee. 1-855-323-DCFS(3237) \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 7;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 8;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table 3D effects 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table 3D effects 2; PDF BCIA 8016 - Request for Live Scan Service - Attorney General of California fffffffffffffffffdfffffffeffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff \sbasedon0 \snext0 index 1;}{\s31\ql \li720\ri0\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 Health, Family Health and Preparedness, Licensing. Salt Lake City, Ut 84116, DLBC Contact Info If you believe a background check has been triggered for some other than the reasons listed above, contact HR Records at hrsc-records@austin.utexas.edu or 512-471-4772. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 KEY: health care facilities, background screening}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 For information on obtaining the Out of State Registry, visit this link on our website: https://dlbc.utah.gov/out-of-state-registries, Submit the fee of $37.25 per application in one of the following forms: Company check, cashiers check, or money order made payable to Department of Human Services. Background Screening Unit. National Suicide Prevention Lifeline \par \tab \hich\af5\dbch\af31505\loch\f5 (3) The covered contractor must ensure the \hich\af5\dbch\af31505\loch\f5 Direct Access Clearance System reflects the current status of the covered individual within 5 working days of placement or termination. In the interest of professionalism, public trust and safety for families and individuals, Utah code requires that all persons associated with a licensed facility (owner, director, governing body, employee, agent, provider, contractor or volunteer) who has or will have direct access to children and/or vulnerable adults must pass a criminal background screening. \par \tab \hich\af5\dbch\af31505\loch\f5 (f) Individuals volunteering services for 20 hours per month or less. The act requires the health facilities and Medicaid community based waiver providers complete a caregiver criminal history screening no later than 20 calendar days after the first day of employment. If the applicant is under 18, include the Criminal Background Screening Authorization with the guardian's signature. Charges will be fairly assessed by the Office of Licensing as described in state law, A licensed program shall not be provided the details of any applicants screenings nor can they disclose screening results except as authorized by Utah or federal law. Where to apply: Department of Public Safety Bureau of Criminal Identification 4315 South 2700 West Suite 1300 Taylorsville, Utah 84129 Phone: (801) 965-4445 Fax: (801) 969-7065 I need to obtain a copy of my Utah criminal history. \lsdpriority46 \lsdlocked0 List Table 1 Light Accent 2;\lsdpriority47 \lsdlocked0 List Table 2 Accent 2;\lsdpriority48 \lsdlocked0 List Table 3 Accent 2;\lsdpriority49 \lsdlocked0 List Table 4 Accent 2; \lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 1;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 1;\lsdpriority70 \lsdlocked0 Dark List Accent 1;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 1;\lsdpriority72 \lsdlocked0 Colorful List Accent 1; \par \tab \hich\af5\dbch\af31505\loch\f5 (a) cause physical or mental harm; \par \tab \hich\af5\dbch\af31505\loch\f5 (v) licensing and certification records of individuals licensed or certified by the Division of Occupational and Professional Licen\hich\af5\dbch\af31505\loch\f5 sing under Title 58, Occupations and Professions; and Apply for a license. In the interest of professionalism, public trust and safety for families and individuals, Utah code requires that all persons associated with a licensed facility (owner, director, governing body, employee, agent, provider, contractor or volunteer) who has or will have direct access to children and/or vulnerable adults must pass a criminal \par \tab \hich\af5\dbch\af31505\loch\f5 (vii) dietary and food service staff; Multi-Agency State Office Building \par \tab \hich\af5\dbch\af31505\loch\f5 (a) a covered employer, or You will get an auto-generated email with a link to an online disclosure form to acknowledge. 1-800-371-7897 \par \tab \hich\af5\dbch\af31505\loch\f5 (a) for residents to live as part of the services provided by the covered provider; and 617020786d6c6e733a613d22687474703a2f2f736368656d61732e6f70656e786d6c666f726d6174732e6f72672f64726177696e676d6c2f323030362f6d6169 Onboarding Applicant - Utah - Health Facility Licensing and Certification \par \tab \hich\af5\dbch\af31505\loch\f5 (g) registries of nurse aids described in Title 42 Code of Federal Regulations Section 483.156; Upon receipt of an official communication from the agency with control over the data, the FBI will make appropriate changes and notify you of the outcome. 7aca147a3e08ad9246bbf33e1637f535c8ede6069a9a9982a6de65cf6f35430899395af5fc251c1ac363b282d811ea3717a211dcbccc25cf36fc4d32cb8a0b39 \hich\af5\dbch\af31505\loch\f5 individual notifying them of the right to appeal in accordance with R432-30. utah department of health and human services division of licensing & background checks office of licensing . {\fbiminor\f31582\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fbiminor\f31583\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fbiminor\f31584\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);} }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Top of Form;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Bottom of Form;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Normal (Web);\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Acronym; I hereby authorize (enter name of requesting agency) Division Public and Behavioral Health, to submit a set of my fingerprints to the Nevada Department Public Safety, Records Bureau for the purpose of accessing and reviewing State of Nevada and FBI criminal history records that may pertain to me. PRIVACY POLICY ACKNOWLEDGEMENT FORM. Criminal Background Check Transfer Form (HS-3299) Transmittal Authorization Form (HS-2978) Charges-Arrest Report Form- Social Media; facebook; twitter . PDF Background Screening Policy - Utah Department of Health 2d51e252394309350d7e8264ec2239ddf0b9891b0b099e8e3065de78818570c93ce6b05ec3e90f21cdb8dd7e4a37898de4929cbb749e20c64ce4889d0f6394ac Out-of-state applicants, or their employers, can call the Division of Criminal Investigation (DCI) to request a state only fingerprint kit to be mailed to them directly at 605. . BCI does not have the authority to modify any records from other state or federal databases. Learn more about the Utah Department of Health & Human Services transition. The FBI has determined that under Public Law 105-251 private entities can receive FBI criminal data. b01d583deee5f99824e290b4ba3f364eac4a430883b3c092d4eca8f946c916422ecab927f52ea42b89a1cd59c254f919b0e85e6535d135a8de20f20b8c12c3b0 \lsdpriority46 \lsdlocked0 List Table 1 Light Accent 6;\lsdpriority47 \lsdlocked0 List Table 2 Accent 6;\lsdpriority48 \lsdlocked0 List Table 3 Accent 6;\lsdpriority49 \lsdlocked0 List Table 4 Accent 6; {\fdbminor\f31559\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbminor\f31561\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fdbminor\f31562\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;} \par \tab \hich\af5\dbch\af31505\loch\f5 (g) a home health agency; or \par \tab \hich\af5\dbch\af31505\loch\f5 (iv) registries of nurse aids described in Title 42 Code of Federal Regulations Section 483.156; PDF Office of Inspector General \paperw12240\paperh15840\margl1440\margr1440\margt1440\margb1440\gutter0\ltrsect By submitting this authorization form, I give my permission to: 1) The . \par Sec. Background checks on prospective employees: Keep required disclosures Your SSAN is needed to keep records accurate because other people may have the same name and birth date. Click here. \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'07);}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc255\levelnfcn255 Box 570, Jefferson City, MO, 65102. (a) . Processing includes making a determination of . This includes foster care, proctor care, professional parent care and adoption for children in custody of a child welfare system, as well as private foster care and refugee foster care. I acknowledge that I have received a copy of the privacy policies from the Florida Department of Law Enforcement and the Federal Bureau of Investigation, which describe the exchange of information where criminal record results will become part of the Care Provider Background Screening Clearinghouse. Please direct inquiries about fingerprinting, Utah criminal records (including expungement or correction procedures) to: Utah Department of Public Safety, Bureau of Criminal Identification (BCI), 3888 West 5400 South \par \tab \hich\af5\dbch\af31505\loch\f5 (a) As required by Utah Code Subsection \hich\af5\dbch\af31505\loch\f5 PDF Information on completing background checks for Medical Cannabis - Utah Process & Instructions for New Screenings. \par \tab \hich\af5\dbch\af31505\loch\f5 (xi) volunteer as defined by \hich\af5\dbch\af31505\loch\f5 department rule. After you do this, you will receive a Livescan Authorization Form to take with you when you get fingerprints done. \par \tab \hich\af5\dbch\af31505\loch\f5 (2) A covered contractor must ensure that the covered individual, being supplied by contract to a covered provider\hich\af5\dbch\af31505\loch\f5 : Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities Division in the Department of Justice (DOJ) collects the information requested on this form as authorized by Business and Professions Code sections 4600-4621, 7574-7574.16, 26050-26059, 11340-11346, and 22440-22449; Penal Code sections 11100-11112, and 11077.1; Health and Safety Code sections 1522, Forms - Tennessee 0000000000000000000000000000000000000000000000000105000000000000}}. As the applicant, you are responsible for providing this fee at the time of the live scan fingerprint appointment, The Rap Back system checks state, regional and national databases for criminal records, By submitting an application, you give consent for the Office of Licensing to monitor all relevant databases for as long as you remain licensed or associated with a licensee, The Office of Licensing will issue a screening clearance or denial, according to standards and procedures outlined in, If you receive clearance on your screening, your application will be returned to the background screening agent that submitted it. \rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid7565795 \hich\af5\dbch\af31505\loch\f5 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 \par \tab \hich\af5\dbch\af31505\loch\f5 (8) "Covered provider" means: If you believe your Identity History Summary contains inaccurate or incomplete information, you have two options for requesting a change or correction: Option 1: Contact the agency or agencies that submitted the information to the FBI. \par How do I Apply for a Concealed Firearm Permit? How to Request a Background Check - University of Texas at Austin The DPS must receive the authorization form with the "original" signature. 288 North 1460 West 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000ffffffffffffffffffffffff000000000000000000000000000000000000000000000000 ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff \par \tab \hich\af5\dbch\af31505\loch\f5 (17) "Volunteer" means an individual who may have unsupervised direct patient access who \hich\af5\dbch\af31505\loch\f5 is not directly compensated for providing services. Background Screening | Division of Licensing and Background Checks - Utah As a new employee of a DHS licensed agency or DHS contracted agency your background screening process will be fully automated in the Direct Access Clearance System (DACS). \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 Authorizing, and Implemented or Interpreted Law: 26-21-9.5}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 There is no charge for the fingerprinting services but the $33.25 Background fee will still apply. Salt Lake City, Ut 84116, DLBC Contact Info This form must be presented to the live scan agent AFTER DACS application is submitted in order for the prints to be linked to the applicant in DACS. 1cac24d91adc3d8d1797de195df3a708422c6cd795011744c0dd413db3e682c0655891c8caf8db294c79da356fa3740c65e388ae62945714339967709dca0b3a \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a hospice that provides living quarters as part of its services. \par }}{\*\ftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14438297 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 { \par \tab \hich\af5\dbch\af31505\loch\f5 (b) commit theft; or (5) The department may allow a current employee to continue to work with conditions, during the reconsideration process as defined in each division's background screening guidelines if the employee can demonstrate the work arrangement does not pose a threat to the department and the safety and health of Utah citizens. 1-800-273-TALK(8255) Last, background screenings are required if you are seeking legal guardianship consent for youth ages 12- to 17-years-old and not living in a foster/adoptive home and not receiving services. Utah Department of Health and Human Services is now one agency. \par \tab \hich\af5\dbch\af31505\loch\f5 (h) licensing and certification records of individuals licensed or certified by the Division of Occupat\hich\af5\dbch\af31505\loch\f5 ional and Professional Licensing under Title 58, Occupations and Professions; and 000000000000d60200007468656d652f7468656d652f7468656d65312e786d6c504b01022d00140006000800000021000dd1909fb60000001b01000027000000 This includes SAS & DSPD Certified Providers. {\fbiminor\f31585\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fbiminor\f31586\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}}{\colortbl;\red0\green0\blue0;\red0\green0\blue255;\red0\green255\blue255;\red0\green255\blue0; AUTHORIZATION FOR BACKGROUND CHECK AND. \par \tab \hich\af5\dbch\af31505\loch\f5 (A) 76-4 Enticement of a Mino\hich\af5\dbch\af31505\loch\f5 r; Fingerprinting and Background Checks - NM Department of Public Safety Criminal Records | DPS - Criminal Identification (BCI) (2) The Department may allow a covered individual direct patient access with conditions, until the arrest or criminal charges are resolved, if the covered individual can demonstrate the work arrangement does not pose a threat to the saf It depends on what the charges are, how long ago they occurred and other considerations, Charges will be fairly assessed by the Office of Licensing as described in state law, A licensed program shall not disclose screening results except as authorized by Utah or federal law, Please allow two weeks for processing and results of your background screening, If after two weeks you have not received results, you may contact the Office of Licensing for an update by emailing, For all other inquiries please call our main line (801) 538-4242 or call your licensor or screening technician directly, Legibly complete and sign and date an application form (see above) for your appropriate area, Submit paperwork to your Background Screening Agent for identification, verification and submission to the Office of Licensing.

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utah department of health criminal background screening authorization form