1-800-371-7897 Each agency is responsible to identify a minimum of two Background Screening Agents to be responsible for training and completing all of the agencys background screening applications in DACS, payments, and all communications with OL regarding background screenings. {\fdbminor\f31566\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhiminor\f31568\fbidi \fswiss\fcharset238\fprq2 Calibri CE;}{\fhiminor\f31569\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr;}
Child Abuse/Neglect The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. PRIVACY POLICY ACKNOWLEDGEMENT FORM. \par
\pndec\pnstart1\pnindent720\pnhang {\pntxta . National Suicide Prevention Lifeline The NICS conducts background checks on people who want to own a firearm or explosive, as required by law. If HCJDC has questions, please contact: Staff Name: Requesting DHS . \par \tab \hich\af5\dbch\af31505\loch\f5 (b) As required by Utah Code Subsection 26-21-204, if an individual or covered individual has a warrant for arrest or an arrest for any of the identified offenses in R43\hich\af5\dbch\af31505\loch\f5
PDF Information on completing background checks for Medical Cannabis - Utah Forms | DSHS - Washington 13. {\*\colorschememapping 3c3f786d6c2076657273696f6e3d22312e302220656e636f64696e673d225554462d3822207374616e64616c6f6e653d22796573223f3e0d0a3c613a636c724d
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. Follow the instructions on page 2 of the form for submitting the form and the payment information. fa3528a6243ddf43d7c25673b85d6d0159327aec8477c360d26ee4ca4b144443115d6a8a254be5a1584bd00bc6270050408a24493db959e1259a43140f112567
Forms. Authority. \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
Headquarters \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. Utah Criminal History Records. {\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;}
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1-800-273-TALK(8255) \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
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with health screenings and immunizations New look, new feelsame goals. 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. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) If the Department denies or revokes a license, or denies direct patient access based upon arrest or criminal charges, the Department shall send a Notice of Agency Action to the covered provider and the covered
\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. 0000000000000000000000000000000000000000000000000105000000000000}}. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 3;
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\par \tab \hich\af5\dbch\af31505\loch\f5 (c) Enterta\hich\af5\dbch\af31505\loch\f5 inment groups;
}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297
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\par \tab \hich\af5\dbch\af31505\loch\f5 (11) "Engage" means to obtain one's services:
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\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 {
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. 000000000000d60200007468656d652f7468656d652f7468656d65312e786d6c504b01022d00140006000800000021000dd1909fb60000001b01000027000000
(Salt Lake City, UT) The Centers for Disease Control and Prevention (CDC) issued recommendations for vaccinating children 5 years of age and younger against COVID-19. Help; \par \tab \hich\af5\dbch\af31505\loch\f5 In addition:
\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
\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. \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;
We strongly believe that health is critical for enjoying a prosperous life. Background checks on prospective employees: Keep required disclosures Utah Domestic Violence National Suicide Prevention Lifeline Applicants also have the option to complete an online version of the Background Check Authorization form . Forms - Tennessee However, if your application has been submitted for longer than three weeks, you can request a status update by emailing cbsunit@utah.gov. Click here. \par \tab \hich\af5\dbch\af31505\loch\f5 (f) Individuals volunteering services for 20 hours per month or less. \par \tab \hich\af5\dbch\af31505\loch\f5
Background Check Request (BCR) (DCF-F-5296) English / Hmong / Spanish Barred Offenses - Regulated Child Care (DCF-P-5206) Child Care Background Check Attestation (DCF-F-5365) English / Spanish (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
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. \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) a disabled individual, as defined by department rule;
Penalties. RULE ANALYSIS Purpose of the rule or reason for the change: The purpose of this new rule is to outline the process for the background screening of Department of Health (Department) employees. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) The covered provider must ensure the Direct Access Clearance System reflects the current status of the covered individual within 5 w\hich\af5\dbch\af31505\loch\f5 orking days of the engagement or termination. National Suicide Prevention Lifeline \par \tab \hich\af5\dbch\af31505\loch\f5 (a) for residents to live as part of the services provided by the covered provider; and
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\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;
Crisis Line & Mobile Outreach Team Live scan operator will sign and return a copy of the form to be uploaded into DACS by the screening agent. 1-888-421-1100 Multi-Agency State Office Building The Live Scan Fingerprint Authorization Form can then be taken to any Utah While it can be somewhat scary at first, it is actually a good thing.
;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0
\par \tab \hich\af5\dbch\af31505\loch\f5 The following groups or individuals are excluded as volunteers and are not required to complete the background clearance process as defined in R432-35:
Third Party Release (use this form only if criminal history information is to be released to a third party) Download. \hich\af5\dbch\af31505\loch\f5 c\hich\af5\dbch\af31505\loch\f5 overed providers. b48cc799fc0d91f134462b381daafb4a492472d591f0564cc0a1911e76ea5678ba4e4ed9223becacd7d5c16656590592e5782d2cc6e1a04a66e856bb3cc02bd4
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\par \tab \hich\af5\dbch\af31505\loch\f5 (e) Patient family members; and
\par }{\*\themedata 504b030414000600080000002100e9de0fbfff0000001c020000130000005b436f6e74656e745f54797065735d2e786d6cac91cb4ec3301045f748fc83e52d4a
\par \tab \hich\af5\dbch\af31505\loch\f5 (f) a hospice;
\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Simple 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Simple 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Classic 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Classic 2;
After you do this, you will receive a Livescan Authorization Form to take with you when you get fingerprints done, Use this form if you provide respite care or babysitting for a foster provider and do not live in the foster home, Fill out the form completely, following the instructions on page 2 of the form, Make sure to include the name of the foster provider and licensor in the appropriate spaces and sign the form. Salt Lake City, Ut 84116, DLBC Contact Info d398af2571687c182716f094313a60dc6985876a2ec3ccb3751ab927e76b13f714a10bd7dc43945a5e1eaf579063894be530c616cd2714a5124538c5d253dfb1
The Department of Human Services, Office of Licensing will establish procedures to ensure removal of my fingerprints from applicable state and federal databases when I am no longer under their purview. \par \tab \hich\af5\dbch\af31505\loch\f5 (i) types and number;
The child care staff member needs to keep a copy of their letter for any future child care employers. d09bd06aa3566b55134452df4b51026a1f2f97648ebd9952e9dfdb2a1f53784da5500373caa74a35b6243476715e5708b11143cabd0b447b3eccb3609733fc52
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. These forms are only to be used by agencies who are authorized by statute, executive order, court rule, court order or local ordinance. Salt Lake City, Ut 84116, DLBC Contact Info 195 North 1950 West Forms - Mississippi State Department of Health (a) As required by Utah Code Subsection 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: (i) any felony or class A conviction under Utah Code. . 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. 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. MVR screening requires an additional consent form. \par \tab \hich\af5\dbch\af31505\loch\f5 (ix) transportation staff;
Obtaining Utah Criminal History Records. 910 E Sioux Ave. Pierre, SD 57501. 1-800-273-TALK(8255) 1-888-421-1100 Salt Lake City, Ut 84116, DLBC Contact Info ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff
\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 4;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Bullet 5;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Number 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 List Number 3;
{\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);}
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Covered Contractor - Direct Access Clearance System Process. {\fhiminor\f31574\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic);}{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);}
\par \tab \hich\af5\dbch\af31505\loch\f5 (c) as a volunteer; or
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This includes SAS & DSPD Certified Providers. \lsdpriority62 \lsdlocked0 Light Grid Accent 1;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 1;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 1;\lsdpriority65 \lsdlocked0 Medium List 1 Accent 1;\lsdsemihidden1 \lsdlocked0 Revision;
\lsdpriority72 \lsdlocked0 Colorful List Accent 6;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 6;\lsdqformat1 \lsdpriority19 \lsdlocked0 Subtle Emphasis;\lsdqformat1 \lsdpriority21 \lsdlocked0 Intense Emphasis;
Screening applications typically take three weeks to process. Prior Authorization - Utah Department of Health Medicaid Until the Office of Licensing has approved the screening, an applicant shall have no direct access to a child of vulnerable adult. A student employee moves to a non-student position. Read More, Salt Lake CityThe Utah Department of Health and Human Services (DHHS) has identified two Utah children younger than age 10 who were treated for hepatitis with Read More, New report shows impact of pandemic on students daily lives Salt Lake CityStudents daily lives and learning were profoundly impacted during the pandemic, according to a Read More. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297
If the applicant is under 18, include the Criminal Background Screening Authorization with the guardian's signature. 7afeb3d9a4d2f13d2151ba4094a5b8e76fb0f03fbbf7eb5fdd454732c609f6403e1547a8e7c752ae8eaa5531876124eeb0154ee1bb25e30992f0caa3ea82a34b
\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Date;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text First Indent;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text First Indent 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Note Heading;
When a person tries to buy a firearm, the seller, known as a Federal . 288 North 1460 West
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Criminal Searches, Instant People Check: Background check includes Multi-Agency State Office Building Licensing. 000000000000000000009d0a00007468656d652f7468656d652f5f72656c732f7468656d654d616e616765722e786d6c2e72656c73504b050600000000050005005d010000980b00000000}
ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff
OL staff will check site rosters for ongoing screening compliance. AUTHORIZATION FOR BACKGROUND CHECK AND. 1-800-273-TALK(8255) \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;
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1-800-897-LINK(5465), https://dlbc.utah.gov/out-of-state-registries, Consent and Privacy Statement for Background Screenings, https://www.fbi.gov/services/cjis/identity-history-summary-checks, Abuse/Neglect of Seniors and Adults with Disabilities.
{\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;}
\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;
\par \tab \hich\af5\dbch\af31505\loch\f5 (i) under the age of 28; or
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\par \tab \hich\af5\dbch\af31505\loch\f5 (C) 76-9-301.8, Bestiality;
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. 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 {\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);}
\par \tab \hich\af5\dbch\af31505\loch\f5 (12) "Long-term care hospital":
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. 534. \lsdpriority70 \lsdlocked0 Dark List Accent 3;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 3;\lsdpriority72 \lsdlocked0 Colorful List Accent 3;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 3;\lsdpriority60 \lsdlocked0 Light Shading Accent 4;
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I also agree that a copy of this form is valid like the signed original. Sec. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff
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 (a) Signs a criminal background screening authorization form which must be available for review by the department; and
1-888-421-1100 One-time Adoption Background Screening Procedure: Background screenings are required for one-time adoptions. Apply for a license. 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. 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. The DPS must receive the authorization form with the "original" signature. Hotlines Abuse/Neglect of Seniors and Adults with Disabilities 1-800-371-7897 Child Abuse/Neglect 1-855-323-DCFS(3237) Utah \lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority39 \lsdlocked0 TOC Heading;\lsdpriority41 \lsdlocked0 Plain Table 1;\lsdpriority42 \lsdlocked0 Plain Table 2;\lsdpriority43 \lsdlocked0 Plain Table 3;\lsdpriority44 \lsdlocked0 Plain Table 4;
licensing requirements {\fhimajor\f31533\fbidi \fswiss\fcharset177\fprq2 Calibri Light (Hebrew);}{\fhimajor\f31534\fbidi \fswiss\fcharset178\fprq2 Calibri Light (Arabic);}{\fhimajor\f31535\fbidi \fswiss\fcharset186\fprq2 Calibri Light Baltic;}
Call: (801) 538-4242 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. DACS Information Worksheet (for use by foster parents and other adults living in foster homes) Background Screening Application - DCFS Foster/Kinship Respite Providers only. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297
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. b01d583deee5f99824e290b4ba3f364eac4a430883b3c092d4eca8f946c916422ecab927f52ea42b89a1cd59c254f919b0e85e6535d135a8de20f20b8c12c3b0
. Health, Administration. 195 North 1950 West 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
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) As required by Utah Code Subsection 26-21-204(4)(a)(ii)(E\hich\af5\dbch\af31505\loch\f5 ), juvenile court records shall be reviewed if an individual or covered individual is:
Salt Lake City, UT 84116. (5) If the Department determines an individual is not eligible for direct patient access, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to the covered contractor and the i
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Sexual Violence Crisis Line Covered Individuals with Arrests or Pending Criminal Charges. Email: dhslicensing@utah.gov, HotlinesAbuse/Neglect of Seniors and Adults with Disabilities \par \tab \hich\af5\dbch\af31505\loch\f5 (i) a nursing assistant;
The screened professions listed below require background screening at initial licensure and/or renewal of licensure. 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.