{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ltrpar d398af2571687c182716f094313a60dc6985876a2ec3ccb3751ab927e76b13f714a10bd7dc43945a5e1eaf579063894be530c616cd2714a5124538c5d253dfb1 earance for a covered individual. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) any felony or class A convi\hich\af5\dbch\af31505\loch\f5 ction under Utah Code. It was the pioneering spirit of two remarkable individuals which would shape the future of public health in Utah for generations to come. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Block Text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Hyperlink;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 FollowedHyperlink;\lsdqformat1 \lsdpriority22 \lsdlocked0 Strong; 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. fa1e4542c2173dbfa6fffceabdbb5574940b517940d6909be8bf5c2e17589c37f49c3c3a2b260d823068f50bfd1a40e53e6edc1eb7c6ad429f06a0f91c569a71 Authority. \par 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. {\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; }{\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 R432-35-5. \lsdpriority51 \lsdlocked0 List Table 6 Colorful;\lsdpriority52 \lsdlocked0 List Table 7 Colorful;\lsdpriority46 \lsdlocked0 List Table 1 Light Accent 1;\lsdpriority47 \lsdlocked0 List Table 2 Accent 1;\lsdpriority48 \lsdlocked0 List Table 3 Accent 1; Until the Office of Licensing has approved the screening, an applicant shall have no direct access to a child or vulnerable adult. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) child abuse or neglect findings described in Section 78A-6-323; \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Keyboard;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Preformatted;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Sample;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 HTML Typewriter; However, if your application has been submitted for longer than three weeks, you can request a status update by emailing cbsunit@utah.gov. : 43003 Filed: 06/15/2018 10:31:45 AM RULE ANALYSIS Purpose of the rule or reason for the change: \par }}{\*\aftnsep \ltrpar \pard\plain \ltrpar\ql \li0\ri0\sl-20\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 { If the employee answers "Yes" to #2 or #3 of the form, court dockets or case reports are required to be submitted along with the application. Health, Family Health and Preparedness, Licensing Rule R432-35 Background Screening -- Health Facilities Notice of Proposed Rule (Amendment) DAR File No. Health, Family Health and Preparedness, Licensing. faadb081f196af190c6a98242f8467912ab0a651ad6a5a548d8cc3c1aafb6121653923699635d3ca2aaa6abab39835c3b60cecd8f26645de60b53531e434b3c2 OL staff will check site rosters for ongoing screening compliance. 1-800-371-7897 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Outline List 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Outline List 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Outline List 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Simple 1; \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Smart Hyperlink;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Hashtag;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Unresolved Mention;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Smart Link;}}{\*\datastore 01050000 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 I have read the attached Privacy Statement and understand my rights according to this statement. \par \tab \hich\af5\dbch\af31505\loch\f5 (13) "Nursing Assistant" means\hich\af5\dbch\af31505\loch\f5 an individual who performs duties under the supervision of a nurse, which may include a nurse aide, personal care aide or certified nurse aide. \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-4. 5689811a183c61a50f98f4babebc2837878049899a52a57be670674cb23d8e90721f90a4d2fa3802cb35762680fd800ecd7551dc18eb899138e3c943d7e503b6 617020786d6c6e733a613d22687474703a2f2f736368656d61732e6f70656e786d6c666f726d6174732e6f72672f64726177696e676d6c2f323030362f6d6169 To schedule an appointment, please click here. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) an aged individual, as defined by department rule; or {\revtim\yr2020\mo4\dy22\hr14\min21}{\version2}{\edmins0}{\nofpages1}{\nofwords2655}{\nofchars15139}{\nofcharsws17759}{\vern125}}{\*\xmlnstbl {\xmlns1 http://schemas.microsoft.com/office/word/2003/wordml}} voluntary, by what statutory or other authority your SSAN is solicited, and what uses will be made of it. \lsdpriority49 \lsdlocked0 Grid Table 4 Accent 2;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 2;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 2;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 2; \par \tab \hich\af5\dbch\af31505\loch\f5 (d) by other arrangement. \hres0\chhres0 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'03. d individual prior to issuance of a provisional license, license renewal or engagement as a covered individual. No appeal is available if you are denied for failure to provide required information, If you close your foster care license, it is your or the screening agents responsibility to inform the Office of Licensing for removal from the ongoing Rap Back system, You are required to disclose all criminal charges, including pending charges, and all supported or substantiated findings of abuse, neglect or exploitation. also require a background screening for one-time clearance. 7468656d652f7468656d652f7468656d654d616e616765722e786d6c504b01022d0014000600080000002100b6f4679893070000c92000001600000000000000 Contact information for states maintaining records at the state level is provided on the State-Maintained Records listing. Headquarters Once the application, forms and fees have been submitted to UDAF, UDAF will send the applicant a "Live Scan Fingerprint Authorization Form" to continue the process. Definitions. Criminal Background Check Transfer Form (HS-3299) Transmittal Authorization Form (HS-2978) Charges-Arrest Report Form- Social Media; facebook; twitter . If there are criminal or abuse/neglect history items to disclose, you are asked to do so in either an uploaded document via your screening agent or if you choose not to share details with them, you may submit directly to OL at cbsunit@utah.gov, please be sure to place the DACS application number and your name and dob on your email or we will not know whose application to link the disclosure to. {\*\latentstyles\lsdstimax376\lsdlockeddef0\lsdsemihiddendef0\lsdunhideuseddef0\lsdqformatdef0\lsdprioritydef99{\lsdlockedexcept \lsdqformat1 \lsdpriority0 \lsdlocked0 Normal;\lsdqformat1 \lsdpriority9 \lsdlocked0 heading 1; You may be eligible to request a conditional clearance per R501-14-7-2if: The following information is required in order to request a conditional approval: If you meet the above criteria, you may request a conditional approval here. The FBI will contact appropriate agencies in an attempt to verify or correct challenged entries for you. \lsdpriority45 \lsdlocked0 Plain Table 5;\lsdpriority40 \lsdlocked0 Grid Table Light;\lsdpriority46 \lsdlocked0 Grid Table 1 Light;\lsdpriority47 \lsdlocked0 Grid Table 2;\lsdpriority48 \lsdlocked0 Grid Table 3;\lsdpriority49 \lsdlocked0 Grid Table 4; Follow the instructions on page 2 of the form for submitting the form and the payment information. National Suicide Prevention Lifeline . \par \tab \hich\af5\dbch\af31505\loch\f5 To outline the process required for individuals to be cleared to have direct patient access while employed by a covered provider, covered contractor or covered employer. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) If the Department determines an individual is not eligible for direct patient access based upon the non-criminal background screening and the ind\hich\af5\dbch\af31505\loch\f5 }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 {\fhiminor\f31574\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic);}{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);} used by Utah Department of Health (UDOH) to determine my eligibility for licensure as a medical cannabis product establishment owners or directors, or . \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). \lsdpriority62 \lsdlocked0 Light Grid Accent 5;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 5;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 5;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 5;\lsdpriority66 \lsdlocked0 Medium List 2 Accent 5; Child Abuse/Neglect Covered Provider - Direct Access Clearance System Process. \par \tab \hich\af5\dbch\af31505\loch\f5 (8) A covered provider that provides services in a residential setting mu\hich\af5\dbch\af31505\loch\f5 Covered Individuals with Arrests or Pending Criminal Charges. \par \tab \hich\af5\dbch\af31505\loch\f5 (vi) the List of Excluded Individuals and Entities database maintained by the United States Department of Health and Human Services' Office of Inspector General. 1-855-323-DCFS(3237) This includes SAS & DSPD Certified Providers. \ql \li0\ri0\sa160\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \fs22\lang1033\langfe1033\loch\f31506\hich\af31506\dbch\af31505\cgrid\langnp1033\langfenp1033 3f2451eced0dae2c082e8761be9969bb979dc9136332de3168aa1a083ae995719ac16db8ec8e4052164e89d93b64b060828e6f37ed1567914b284d262452282e \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 1;}{\s22\ql \li720\ri720\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a small health care facility; \par \qj \li0\ri0\sl240\slmult0\nowidctlpar\wrapdefault\hyphpar0\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \par \tab \hich\af5\dbch\af31505\loch\f5 (8) "Covered provider" means: \par \tab \hich\af5\dbch\af31505\loch\f5 (a) an end stage renal disease facility; 26-21-204, if an individual or covered individual has been convicted, has pleaded no contest, or is subject to a plea in abeyance or diversion agreement, for the following offenses, they may not have direct patient access: Call: (801) 538-4242 Contact. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) Submits fingerprints within 15 working days of placement with a covered provider. This screening requires a separate application (see below). \par \tab \hich\af5\dbch\af31505\loch\f5 (ix) transportation staff; In addition, any such agency in the Federal Executive Branch has also published notice in the Federal Register describing any system(s) of records in which that agency may also maintain your records, including the authorities, purposes, and routine uses for the system(s). fffffffffffffffffdfffffffeffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff 13) of the Utah State Bulletin. Before a determination is made, I understand that I will be afforded a reasonable amount of time to challenge the completeness and accuracy of the record through the procedures established by the Department of Human Services, Office of Licensing as well as contacting the Utah Bureau of Criminal Identification (Utah Criminal History Results), the State Identification Bureau (SIB) associated with any results that are outside of Utah, or the Federal Bureau of Investigation (Nationwide Criminal History Response Information). \par \tab \hich\af5\dbch\af31505\loch\f5 (2) If th\hich\af5\dbch\af31505\loch\f5 Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities 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 (12) "Long-term care hospital": Obtaining Utah Criminal History Records. \lsdpriority49 \lsdlocked0 List Table 4 Accent 1;\lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 1;\lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 1;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 1; (Amendment) DAR File No. e Department determines an individual is not eligible for direct patient access based upon the criminal background screening and the individual disagrees with the information provided by the Criminal Investigations and Technical Services Division or court Criminal Background Screening Published: Nov 30, 2022 Responsible Unit: Vice President for Human Resources 1. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 envelope address;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 envelope return;\lsdsemihidden1 \lsdlocked0 footnote reference;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 annotation reference; \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toa heading;}{\s33\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af31507\afs24\alang1025 \ltrch\fcs0 1-800-897-LINK(5465). Applicant must provide all known substantiated findings of abuse, neglect or exploitation or any felony criminal history to the department upon submission of the criminal history screening application. \par \tab \hich\af5\dbch\af31505\loch\f5 This rule is adopted pursuant to Title 26 Chapter 21 Part 2. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) which may include: he covered employer and the individual explaining the action and the individual's right of appeal as defined in R432-30. \par \tab \hich\af5\dbch\af31505\loch\f5 (c) view medical or financial records. If the individual is not eligible for cl \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 \lsdpriority66 \lsdlocked0 Medium List 2 Accent 4;\lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 4;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 4;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 4;\lsdpriority70 \lsdlocked0 Dark List Accent 4; \par }}{\*\aftncn \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 { \lsdpriority61 \lsdlocked0 Light List Accent 4;\lsdpriority62 \lsdlocked0 Light Grid Accent 4;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 4;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 4;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 4; Child Abuse/Neglect 195 North 1950 West The top portion needs to be signed by the applicant, the bottom portion is signed by the non-licensed entity. This includes citizens and noncitizens. BCI does not have the authority to modify any records from other state or federal databases. Providers do not need to submit payment if there is a fee indicated. Utah Department of Health and Human Services is now one agency. 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. \par \tab \hich\af5\dbch\af31505\loch\f5 (c) is\hich\af5\dbch\af31505\loch\f5 not a licensed health care facility within the state. \par \tab \hich\af5\dbch\af31505\loch\f5 (1) if significant problems exist that are likely to lead to the harm of an individual resident, the department may impose a \hich\af5\dbch\af31505\loch\f5 civil penalty of $50 to $1,000 per day; and \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 8;}{\s29\ql \fi-720\li720\ri0\sl240\slmult0\nowidctlpar \rtlch\fcs1 \af5 \ltrch\fcs0 \insrsid7565795 \chftnsepc Call: (801) 538-4242 Learn more about the recall on Similac, Alimentum and Elecare powder formulas. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Balloon Text;\lsdpriority39 \lsdlocked0 Table Grid;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Theme;\lsdsemihidden1 \lsdlocked0 Placeholder Text; Bureau of Central Services. {\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;} How do I Renew my Concealed Firearm Permit? \par \tab \hich\af5\dbch\af31505\loch\f5 (4) A covered provider may provisionally engage a covered individual while direct patient access clearance is pending. Crisis Line & Mobile Outreach Team 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. \paperw12240\paperh15840\margl1440\margr1440\margt1440\margb1440\gutter0\ltrsect \lsdpriority50 \lsdlocked0 List Table 5 Dark Accent 6;\lsdpriority51 \lsdlocked0 List Table 6 Colorful Accent 6;\lsdpriority52 \lsdlocked0 List Table 7 Colorful Accent 6;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Mention; \par \tab \hich\af5\dbch\af31505\loch\f5 (c) a hospice; Background checks will be repeated on a regular basis; every year for the NYS Sex Offenders' Registry, every 3 years for the Criminal History File check and MVR check. \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; \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) child abuse or neglect findings described in Section 78A-6-323; \par \tab \hich\af5\dbch\af31505\loch\f5 (2) "Clearance" means approval by the department under Section 26-21-203 for an individual to have direct patient access. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Number;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List 3; Request a Conditional Approval You may be eligible to request a conditional clearance per R501-14-7-2 if: You do not reside in a foster home; and \par \tab \hich\af5\dbch\af31505\loch\f5 (c) an assisted living facility; or 13. Exclusion from Direct Patient Access. How do I Apply for a Concealed Firearm Permit? ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff My personal information and fingerprints may be retained for ongoing monitoring and comparison against future submissions to the state, regional or federal database and latent fingerprint inquiries}. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text Indent 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text Indent 3; }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \par \tab \hich\af5\dbch\af31505\loch\f5 (1) Utah Code, Title 26, Chapter 21, Part 2 requires that a covered employer be allowed to enter required information into the Direct Access Clearance System to initiate and obtain a cl\hich\af5\dbch\af31505\loch\f5 6bb6913e68dd1250b2d721614c6693683a48b4b783ca48fa58178ce620a157f65158741d2c3a4afdd6557b2c805ae115f8c1edc1cff49e1f06200242701e07cd Salt Lake City, UT 84116. Background Screening Application - Youth Transport Company employeees only. {\flomajor\f31514\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flomajor\f31515\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flomajor\f31516\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);} \lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 4;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 4;\lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 5;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 5; 432KB Noncriminal Justice Applicant's Privacy Rights Form 1081 Form Instructions 177KB Health Care Mississippi Background Check 192KB Regular Mississippi Background Check 171KB Applicants Living in Another State 169KB \expnd0\expndtw-3\insrsid14438297 (a) Signs a criminal background screening authorization form which must be available for review by the department; and (b) Submits fingerprints within 15 working days of engagement. \par \tab \hich\af5\dbch\af31505\loch\f5 (G) 62A-3-30\hich\af5\dbch\af31505\loch\f5 5 failure to report suspected abuse, neglect, or exploitation of a vulnerable adult. Covered Employer - Direct Access Clearance System Process. If HCJDC has questions, please contact: Staff Name: Requesting DHS . \par \tab \hich\af5\dbch\af31505\loch\f5 (e) a personal care agency. {\flominor\f31548\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\flominor\f31549\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\flominor\f31551\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;} {\fdbmajor\f31522\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbmajor\f31523\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbmajor\f31524\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);} Salt Lake City, Ut 84116, DLBC Contact Info {\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;} }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \par \tab \hich\af5\dbch\af31505\loch\f5 (2) The covered provider must ensure that the engaged covered individual: \par \tab \hich\af5\dbch\af31505\loch\f5 (b) is not a covered provider; and 8376bf330efaaff23606569ea58fdc16605ecdebde7f010000ffff0300504b0304140006000800000021000dd1909fb60000001b010000270000007468656d65 \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a covered provider for services within the scope of the health facility license. They will enter your information in our DACS system, and you will get an auto-generated email with a link to an online disclosure form to acknowledge. Salt Lake City, Ut 84116, DLBC Contact Info 2018, No. Results from the in-state and out-of-state screening process will be mailed to providers in the form of a letter once completed. \lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 3;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 3;\lsdpriority48 \lsdlocked0 Grid Table 3 Accent 3;\lsdpriority49 \lsdlocked0 Grid Table 4 Accent 3; Background screenings are required if you wish to provide foster care in your home for a child in the public welfare system. \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 5;}{\s26\ql \fi-720\li720\ri0\sl240\slmult0\nowidctlpar\tqr\tx9360\wrapdefault\hyphpar0\faauto\rin0\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 (2) The covered provider must ensure that the engaged covered individual: (a) Signs a criminal background screening . Wisconsin Background Check Forms & Publications Here's a variety of forms and publications to help you with the Background Check process. {\flomajor\f31511\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flomajor\f31512\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flomajor\f31513\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);} \lsdqformat1 \lsdpriority1 \lsdlocked0 No Spacing;\lsdpriority60 \lsdlocked0 Light Shading;\lsdpriority61 \lsdlocked0 Light List;\lsdpriority62 \lsdlocked0 Light Grid;\lsdpriority63 \lsdlocked0 Medium Shading 1;\lsdpriority64 \lsdlocked0 Medium Shading 2; These forms are only to be used by agencies who are authorized by statute, executive order, court rule, court order or local ordinance. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) address; and \lsdpriority67 \lsdlocked0 Medium Grid 1 Accent 6;\lsdpriority68 \lsdlocked0 Medium Grid 2 Accent 6;\lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 6;\lsdpriority70 \lsdlocked0 Dark List Accent 6;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 6; }{\field{\*\fldinst {\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 PRIVATE }{ \par \tab \hich\af5\dbch\af31505\loch\f5 (a) by employmen\hich\af5\dbch\af31505\loch\f5 t; 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. Renewing your background screening is no longer necessary if you are in our DACS system and enrolled in Rapback. Human Services. If the email address is not legible or comes back invalid, it will be sent via USPS to the address listed for the non-licensed entity.
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