\par \tab \hich\af5\dbch\af31505\loch\f5 (a) means a hospital that is certified to provide long-term care services under the provisions of 42 U.S.C. One-time Adoption Background Screening Procedure: Background screenings are required for one-time adoptions. \lsdpriority72 \lsdlocked0 Colorful List Accent 6;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 6;\lsdqformat1 \lsdpriority19 \lsdlocked0 Subtle Emphasis;\lsdqformat1 \lsdpriority21 \lsdlocked0 Intense Emphasis; The form must be notarized and the fee is $15.00 per record check, which should be a money order or cashier"s check made payable to the Department of Public Safety. \par \tab \hich\af5\dbch\af31505\loch\f5 \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 { \rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid7565795 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 1-800-897-LINK(5465), Abuse/Neglect of Seniors and Adults with Disabilities. 8376bf330efaaff23606569ea58fdc16605ecdebde7f010000ffff0300504b0304140006000800000021000dd1909fb60000001b010000270000007468656d65 You may submit an Identity History Summary challenge to the FBI by writing to the following address: Attention: Criminal History Analysis Team1 1000 Custer Hollow Road, Headquarters \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 \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. 534. No hard copies of clearances will be required of programs, as all clearance information will be maintained in the DACS program. : 43144 Filed: 08/10/2018 09:20:21 AM. Utah Admin. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) an end stage renal disease facility; Forms. Call: (801) 538-4242 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Balloon Text;\lsdpriority39 \lsdlocked0 Table Grid;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Theme;\lsdsemihidden1 \lsdlocked0 Placeholder Text; \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) passage of time; {\fhiminor\f31506\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri;}{\fbiminor\f31507\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f529\fbidi \froman\fcharset238\fprq2 Times New Roman CE;} Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBIs Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. Your written request should clearly identify the information that you feel is inaccurate or incomplete and should include copies of any available proof or supporting documentation to support your claim. Policy Statement This policy establishes the general guidelines, requirements, and processes for the University of Florida Human Resources (UFHR) and UF hiring departments in evaluating and treating criminal background checks on current or prospective employees, volunteers, and . \paperw12240\paperh15840\margl1440\margr1440\margt1440\margb1440\gutter0\ltrsect Routine uses include, but are not limited to, disclosures to: employing, governmental or authorized non-governmental agencies responsible for employment, contracting licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety. \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; \lsdpriority50 \lsdlocked0 Grid Table 5 Dark;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful;\lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 1;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 1; b01d583deee5f99824e290b4ba3f364eac4a430883b3c092d4eca8f946c916422ecab927f52ea42b89a1cd59c254f919b0e85e6535d135a8de20f20b8c12c3b0 This action is part . \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Normal Indent;\lsdsemihidden1 \lsdlocked0 footnote text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 annotation text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 header; \par \tab \hich\af5\dbch\af31505\loch\f5 (4) Review of Relevant Information \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. 5cd829496313fbb938871045de13265df05366ef10f50e7e40e941773f27d872f787b3c133c8b026a53240d4376beef0e57dccacf89d6ee8126157aae9f3c44a Background Screening. List of Certified Concealed Firearm Instructors, Information for Concealed Firearm Instructors, Concealed Firearm Permit Forms / Instructor Forms, Utah Missing Persons Clearinghouse Functions, Surety Bond and Liability Insurance Information, Documentation of Experience and Qualifications, Concealed Firearm Permit Instructor Applications, Employment/Volunteer Background Check Forms, Application to Become a Qualified Entity for Background Checks on Employees or Volunteers, Authorization to Transfer FBI Rapback Subscription NCPA/VCA, Authorization to Transfer FBI Rapback Subscription School Employees, Authorization to Transfer WIN Rapback Subscription Tow Truck Operators. \par \tab \hich\af5\dbch\af31505\loch\f5 (c) federal criminal background databases available to the state; The following factors may be \lsdpriority49 \lsdlocked0 Grid Table 4 Accent 6;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 6;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 6;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful Accent 6; These forms are only to be used by agencies who are authorized by statute, executive order, court rule, court order or local ordinance. Medical Cannabis Production Establishment Agent Criminal Background Screening Authorization Form First Name: Last Name: I understand that my personal information including name, DOB, SSN and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. \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 Before you get a background screening report about a prospective employee, disclose to the person that you intend to get the report and then get their written authorization allowing you to do that. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) the severity of offense; and If identifying information is missing (such as name ) your form will be returned . A check or money order made payable to the "Utah Department of Health" may be . ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff 1-801-587-3000 \sbasedon0 \snext0 toc 4;}{\s25\ql \li720\ri720\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \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 I have read the attached Privacy Statement and understand my rights according to this statement. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) for residents to live as part of the services provided by the covered provider; and Salt Lake City, Ut 84116, DLBC Contact Info Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities \par \tab \hich\af5\dbch\af31505\loch\f5 (b) Religious groups; employee signs and dates section 5 of the application. used by Utah Department of Health (UDOH) to determine my eligibility for licensure as a medical cannabis product establishment owners or directors, or . Background Screening FAQ. This meeting requires the screening agent to verify the applicants identification and enter information contained on the identification into DACS. \par \tab \hich\af5\dbch\af31505\loch\f5 (9) Covered providers requesting to renew a license as a health care facility must utilize the Direct Acce\hich\af5\dbch\af31505\loch\f5 \par \tab \hich\af5\dbch\af31505\loch\f5 (7) "Covered individual": Option 2: Send a written challenge request to the FBI. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff DACS Information Worksheet (for use by foster parents and other adults living in foster homes), Background Screening Application DCFS Foster/Kinship Respite Providers only, Background Screening Application Youth Transport Company employeees only, Background Screening Application Adoption (One-time adoption application no RapBack or Adam Walsh clearance). st enter required information into the Direct Access Clearance System to initiate and obtain a clearance for all individuals 12 years of age and older, who are not residents, and reside in the residential setting. \expnd0\expndtw-3\insrsid14438297 \par \tab \hich\af5\dbch\af31505\loch\f5 (6) A covered contractor may not supply to a covered provider a covered individual who has been determined to be not eligible to have direct patient access. fa1e4542c2173dbfa6fffceabdbb5574940b517940d6909be8bf5c2e17589c37f49c3c3a2b260d823068f50bfd1a40e53e6edc1eb7c6ad429f06a0f91c569a71 \lsdpriority71 \lsdlocked0 Colorful Shading Accent 4;\lsdpriority72 \lsdlocked0 Colorful List Accent 4;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 4;\lsdpriority60 \lsdlocked0 Light Shading Accent 5;\lsdpriority61 \lsdlocked0 Light List Accent 5; \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 {\rtlch\fcs1 \af31507 \par \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-9. Fingerprints are required to be submitted to the Florida Department of Law Enforcement electronically. Background screenings are required if you wish to provide foster care in your home for a child in the public welfare system. \expnd0\expndtw-3\insrsid14438297 \pndec\pnstart1\pnindent720\pnhang {\pntxta . fffffffffffffffffdfffffffeffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff 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. Instructions and applications are located at the following web address: https://bci.utah.gov/wp-content/uploads/sites/15/2017/08/ROA-8-24-2017.pdf, https://www.fbi.gov/services/cjis/identity-history-summary-checksChallenge of an Identity History Summary. 3. voluntary, by what statutory or other authority your SSAN is solicited, and what uses will be made of it. dc9ae318d601feffffff00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000ffffffffffffffffffffffff00000000000000000000000000000000000000000000000000000000 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. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) child abuse or neglect findings described in Section 78A-6-323; \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; The NICS conducts background checks on people who want to own a firearm or explosive, as required by law. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) Non-Criminal Records \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 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. 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 4. BCI does not have the authority to modify any records from other state or federal databases. 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, 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. Crisis Line & Mobile Outreach Team Sexual Violence Crisis Line \par \tab \hich\af5\dbch\af31505\loch\f5 (F) 76-10-1301 to 1314, Prostitution; and TO RELEASE FINDINGS. The needs of our communities continue to change as more and more people choose to make Utah their home. Sexual Violence Crisis Line 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. For eligibility questions or concerns: 1-866-435-7414 \par \tab \hich\af5\dbch\af31505\loch\f5 (b) does not include a critical access hospital, designated under 42 U.S.C. Fingerprints: Submit 2 correctly-rolled fingerprint cards per applicant to the Office, which we will submit to the Office of Public Safety to fulfill FBI requirements. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) means an individual: Online Background Check Authorization form for Applicants. 13. 9c7827248a21f056286502866b8ddaa4d684ffea13e827ed5174849121ad780113b137a4f87862cec94af6fc07a0d537206f7ffef9cdeb1fdfbcfee9cd575fbd Call: (801) 538-4242 \par \tab \hich\af5\dbch\af31505\loch\f5 (4) "Corporation" means a corporation that has business interest/connection to covered providers that employ individuals who provide consultative services which may result in direct patient access. \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; Multi-Agency State Office Building d09bd06aa3566b55134452df4b51026a1f2f97648ebd9952e9dfdb2a1f53784da5500373caa74a35b6243476715e5708b11143cabd0b447b3eccb3609733fc52 I agree the Company may rely on this authorization to order background reports, including investigative consumer reports, from companies other than the Background Check Company without asking me for my authorization again as allowed by law. \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 Apply for a license. \par \par \tab \hich\af5\dbch\af31505\loch\f5 (c) Enterta\hich\af5\dbch\af31505\loch\f5 inment groups; 1-800-273-TALK(8255) The background screening unit will notify the provider and the child care staff member of the results determining if they are eligible or ineligible to work or be present in a licensed, regulated, or registered child care facility. Definitions. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) cause physical or mental harm; \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; Purpose. \par \tab \hich\af5\dbch\af31505\loch\f5 (iv) a provider of medical, therapeutic, or social services, including a provider of laboratory and radiology\hich\af5\dbch\af31505\loch\f5 services; \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 \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a long-term care hospital; (3) The covered provider must ensure that DACS reflects the current status of the covered individual within 5 working days of the engagement or termination. Salt Lake City, Ut 84116, DLBC Contact Info Section R432-35-4 - Covered Provider - DACS Process (1) Covered providers shall enter required information into DACS to initiate a clearance for each covered individual prior to issuance of a provisional license, license renewal or engagement as a covered individual. 7ce8306e3b99fc70e5e3743265f3027d8d3af0c80e7af4b14f72f0d46749289dca0dc527421ffc08f83db398c0a092d3279eb838055cc5f0a8ca1c4c60e1228e exclude the individual from direct patient access if the adjudications refer to an act that, if committed by an adult, would be a felony or a misdemeanor. 4757e8d3f729e245eb2b260a0238fd010000ffff0300504b030414000600080000002100b6f4679893070000c9200000160000007468656d652f7468656d652f Salt Lake City, Ut 84116, DLBC Contact Info \par \tab \hich\af5\dbch\af31505\loch\f5 (e) an assisted living facility; \par \tab \hich\af5\dbch\af31505\loch\f5 (10) Individuals or covered individuals requesting to be licensed as a c\hich\af5\dbch\af31505\loch\f5 I understand that I may request to review any results of this inquiry and understand that UCA 53-10-108 does not allow the. b17d4e9cd131584756689f604cd1255a60ec3dfbdcc160c05696cd4bd20f62c82ac7d815580f901dabea3dc5027a25d5dcece7c91322ac909de2881de073bad9 Read section 6 and sign/date the bottom of the form, Submit the form to your licensor or your Foster/Adoptive Consultant with Utah Foster Care. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) Patient family members; and 1-855-323-DCFS(3237) It was the pioneering spirit of two remarkable individuals which would shape the future of public health in Utah for generations to come. 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.