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This affidavit is used by applicants of the Caregivers Criminal History Screening Program to declare that they do not have any felony convictions and to provide information related to their residency and employment history, along with necessary personal details for background verification.
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How to fill out caregivers criminal history screening

01
Obtain the caregiver criminal history screening form from the relevant authority or agency.
02
Carefully read the instructions provided on the form.
03
Fill out your personal information, including your name, address, and date of birth accurately.
04
Provide any required identification details, such as a driver's license number or Social Security number.
05
Disclose any previous addresses as specified on the form.
06
Answer any questions regarding your criminal history honestly.
07
Include fingerprint information if required. This may involve visiting a local law enforcement agency or approved provider.
08
Attach any required documentation as indicated on the form.
09
Review the completed form for accuracy and completeness.
10
Submit the form and any accompanying documents to the designated agency or authority by the specified deadline.

Who needs caregivers criminal history screening?

01
Individuals seeking employment as caregivers in nursing homes, assisted living facilities, or home health services.
02
Organizations hiring caregivers to ensure safety and well-being of vulnerable populations, such as the elderly or disabled.
03
Regulatory bodies requiring background checks for certification or licensing of caregivers.
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Caregivers criminal history screening is a process used to check the criminal background of individuals who provide care services to vulnerable populations, ensuring that they have no serious criminal offenses that could pose a risk to those in their care.
Individuals applying for caregiver positions, including personal care aides, healthcare workers, and in some cases, family members or legal guardians who provide caregiving services, are required to file for caregivers criminal history screening.
To fill out caregivers criminal history screening, applicants typically need to complete a designated form provided by the relevant authority, providing personal information such as name, address, date of birth, and any history of criminal offenses.
The purpose of caregivers criminal history screening is to protect vulnerable populations, such as children, the elderly, and individuals with disabilities, by ensuring that caregivers do not have a history of violent or harmful behavior.
Information that must be reported includes the applicant's full name, date of birth, social security number, residence history, and any past criminal offenses, including misdemeanors and felonies.
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