Contents
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Record Check Authorization Details
This Record Check information is presented for completion during the Initial Licensing Visit Request and Registered Home Application processes, as well as, whenever a new associated party (person) for a provider is being entered into the system.
The following fields are entered on this page:
Record Check Reason
One of the following will be captured during the process where the information is entered:
License Application/Reapplication
Provider Investigation
New Hire
Other Last and First Names Used: (separated by commas)
This field is used to capture any other last names used by the associated party other than the name entered as the First and Last Name. These could include maiden, aliases, etc.
Date of Birth
The date of birth is used to perform searches and verify information found in the outside criminal history registries.
SSN (Social Security Number)
The Social Security Number is also used to perform searches and verify information found in the outside criminal record registries.
Contact Phone
The telephone number would be used for contacting the person if necessary.
Birth City and Birth State
This information could be used to search out of state records or to verify information found in the criminal history registries.
Conviction Question
Each applicant is required to answer the following question with a Yes or No.
"Has applicant ever been convicted or found by a court to have committed fraud, felony or an offense involving violence or unlawful sexual activity, or other bodily injury to another person, including, but not limited to abuse, neglect or sexual activity with a child?"
Authorization Signed?
If the Record Check Authorization form contains a signature, a Yes is entered in this field. If no signature date has been entered, a No is entered in this field.
Authorized Date
The date that appears on the Record Check Authorization form is captured in this field if the authorization has been signed.