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In the heart of efforts to safeguard children from any form of harm is the Alabama Central Registry Clearance form, a crucial document overseen by the Alabama Department of Human Resources. Ensuring the safety and welfare of children, this form serves as a vetting instrument for individuals who are poised to engage in roles that entail the unsupervised care and supervision of minors, whether they aim to work as employees or serve as volunteers. It meticulously records the applicant’s detailed personal information, including name, gender, race, date of birth, and any aliases or previous names, alongside a comprehensive history of residences and employment in Alabama counties. Critical to its process is the requirement for applicants to grant the Department the authority to release information contained within the Child Abuse/Neglect (CA/N) Central Registry about them, effectively waiving their rights to review or hearing. This clearance form not only streamlines the process for various agencies and organizations like child placing agencies, residential child care facilities, and child day/night care centers but also stands as a testament to Alabama's commitment to preventing child abuse and neglect. By specifying the context in which the applicant will interact with children and carrying out a thorough search in the CA/N Central Registry, the form acts as a gateway to ensure that only individuals with no history of substantiated abuse or neglect reports are given the responsibility of caring for children, thus reinforcing the safety net around Alabama's youngest and most vulnerable citizens.

Preview - Alabama Central Registry Clearance Form

ALABAMA DEPARTMENT OF HUMAN RESOURCES

CHILD ABUSE / NEGLECT (CA/N) CENTRAL REGISTRY CLEARANCE

PRINT OR TYPE in black or blue ink. Additional information regarding the CA/N Central Registry is on the back of this form.

** See instructions for the address to use when submitting this form. **

Requesting Person or Agency/Organization

 

 

Check All That Apply

 

 

 

 

 

 

Mailing Address

 

 

 

 

Child Placing Agency

 

 

 

 

 

 

 

 

 

 

 

Residential Child Care Facility

 

 

 

 

 

 

 

 

 

 

 

Child Day / Night Care Center

 

 

 

 

 

 

Telephone Number (

)

 

Email:

 

Family Day / Night Care Home

 

 

 

 

 

 

PRINT Requestor’s Name

 

 

 

 

Exempt Child Day Care Center

 

 

 

 

 

 

Requestor

 

 

 

Date

Medicaid Rehab. Provider

Signature

 

 

 

 

DHR Vendor

 

 

 

 

 

 

Witness

 

 

 

Date

Other (Please Specify)

Signature

 

 

 

 

_________________________________

 

 

 

 

 

The person whose name and identifying information, printed or typed below, will provide unsupervised care and

supervision of children as an

employee

volunteer

other. This person’s specific job/role is or will be:

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Name _____________________________________________ Sex

Last First Middle

Male

Race ___________ DOB ___/___/______

Female

 

Current Mailing Address

__________________________________________________________________________

Alias, Maiden & Prior Married Name(s)

______________________________________________________________

Name & DOB of Spouse & Former Spouse(s)

_________________________________________________________

Name & DOB of Children / Stepchildren

______________________________________________________________

Alabama counties where person has lived and/or worked

_________________________________________________

Attach additional pages as needed to provide all information requested above.

To be completed by person being cleared

I authorize the Alabama Department of Human Resources to release information contained in the Child Abuse / Neglect Central Registry about me to the above named person/agency/organization. I hereby waive any right to any review or hearing to which I may otherwise be entitled. I further release the Department of Human Resources, its officers, and employees from any and all claims arising out of or in any way connected to the release or dissemination of any information concerning me.

_________________________________

________________

_________________________________

________________

Signature

Date

Signature of Witness

Date

To be completed by DHR

A search of the Alabama Child Abuse / Neglect Central Registry has been completed with the information provided to determine if the person identified above has been named as being responsible for child abuse or neglect in Alabama. DHR releases only that information which is necessary to discover or prevent child abuse / neglect.

Substantiated report (i.e., indicated) located. See attached information.

Type Report:

Physical Abuse

Neglect

Sexual Abuse

Mental Abuse / Neglect

No report located.

 

 

 

 

Request Denied

______________________________________________________________________________

Other _________________________________________________________________________________________

_________________________________________________________

______________________________________

Office of Child Protective Services

 

 

Date Completed

DHR-FCS-1598 (Revised December 2009)

Form Data

Fact Number Fact Name Description
1 Purpose of the Form The form is used to request clearance from the Alabama Department of Human Resources Child Abuse / Neglect (CA/N) Central Registry.
2 Ink Requirement The form must be filled out in black or blue ink.
3 Additional Information Availability Additional information about the CA/N Central Registry is provided on the back of the form.
4 Submission Address Instructions Instructions for the address to use when submitting this form are included in the form's instructions.
5 Entities That Can Request Clearance The form can be requested by child placing agencies, residential child care facilities, child day/night care centers, family day/night care homes, exempt child day care centers, Medicaid rehab providers, DHR vendors, and others specified.
6 Information Required From the Person Being Cleared Identifying information including name, sex, race, date of birth, mailing address, alias, maiden, and prior married names, as well as information about family and counties of residence or work in Alabama, are required.
7 Consent and Waiver By signing the form, the individual consents to the release of their information from the CA/N Central Registry and waives the right to any review or hearing otherwise entitled.
8 Liability Release The signer releases the Department of Human Resources and its officers and employees from any claims related to the release of information.
9 Completion by DHR The Alabama Department of Human Resources completes the form indicating whether a substantiated report of abuse or neglect has been located, and what type of report it is, if applicable.
10 Governing Law The process and use of the Alabama CA/N Central Registry Clearance form are governed by the laws and regulations of the State of Alabama.

Instructions on Utilizing Alabama Central Registry Clearance

Fulfilling the Alabama Central Registry Clearance form is a critical step for individuals who will be providing unsupervised care and supervision of children, covering a range of roles from employees to volunteers within various childcare settings. This form is used by the Alabama Department of Human Resources to ensure that individuals have no history of child abuse or neglect. Once completed, this form provides peace of mind for both the caregiver and the employer or agency by ensuring a safe environment for children. Below, you will find a clear, step-by-step guide to completing this important document.

  1. Use black or blue ink to print or type the requested information within the form.
  2. Under the "Requesting Person or Agency/Organization" section, select the category that best describes the requesting body from the options provided.
  3. Enter the mailing address of the requesting person or agency/organization.
  4. Provide the appropriate telephone number and email address for contact purposes.
  5. In the space provided, print the requestor’s name. Adjacent to this, fill in the date and have the form witnessed with both the witness's signature and the date.
  6. For the section describing the role of the person being cleared, detail the specific job or role they will hold, focusing on their responsibilities related to the unsupervised care and supervision of children.
  7. Input the full name (last, first, middle), sex (male or female), race, and date of birth (DOB) of the individual being cleared.
  8. Record the current mailing address of the person being cleared.
  9. List any alias, maiden, and prior married name(s) that the individual may have used.
  10. Enter the name and DOB of the spouse and any former spouses, as well as the name and DOB of children/stepchildren.
  11. Detail all Alabama counties where the individual has lived and/or worked. Attach additional pages if necessary to include all required information.
  12. In the section to be completed by the person being cleared, the individual will need to sign and date the form, authorizing the Alabama Department of Human Resources to release information from the Child Abuse/Neglect Central Registry. A witness must also sign and date this section.
  13. Ensure that all information is accurate and that no sections are missed before submitting the form to the address provided in the instructions accompanying the form.

It is essential that every step is followed carefully and that the information provided is complete and accurate to avoid any delays in the clearance process. Accurate completion of this form facilitates the timely and effective screening of individuals to protect the welfare of children in Alabama. Upon submission, the form undergoes review by the Department of Human Resources, concluding with either clearance for involvement with children or the identification of concerns requiring further attention.

Obtain Answers on Alabama Central Registry Clearance

  1. What exactly is the Alabama Central Registry Clearance form?

    The Alabama Central Registry Clearance form is an official document used by the Alabama Department of Human Resources. Its purpose is to check if an individual has been named as responsible for child abuse or neglect in Alabama. This form is mainly requested for persons who will be providing unsupervised care and supervision of children, including employees, volunteers, or in any other capacity. By completing this form, the Alabama Department of Human Resources can release information contained in the Child Abuse/Neglect (CA/N) Central Registry about the individual in question.

  2. Who needs to fill out this form?

    This form must be completed by individuals or entities requesting information about a person's background related to child abuse or neglect. These requesters can include child placing agencies, residential child care facilities, child day/night care centers, family day/night care homes, exempt child day care centers, Medicaid rehab providers, DHR vendors, or any other organizations that require unsupervised care and supervision of children by the person whose information is being checked.

  3. How should the form be filled and submitted?

    The form should be filled out in black or blue ink. All relevant sections must be completed, including the information of the person or agency making the request, the details of the person being checked, and any aliases or previous names they may have used. The person being checked must sign the form, authorizing the Department of Human Resources to release information from the Central Registry. Detailed instructions for the address and method of submitting the form are provided on the back of the form itself.

  4. What kind of information is released through this clearance?

    The Alabama Department of Human Resources releases information indicating whether the person in question has been named in the Child Abuse/Neglect Central Registry as being responsible for child abuse or neglect. This can include types of reported abuse such as physical, neglect, sexual, or mental. The department releases only the information necessary to discover or prevent child abuse or neglect.

  5. What happens if a report is located or the request is denied?

    If a substantiated report of abuse or neglect is found in the registry for the person being checked, detailed information about the type of report will be attached. In cases where no report is found or if the request is denied for any reason, the requesting party will be informed accordingly. The specific reasons for denial, if applicable, will also be provided on the completed form.

  6. Are there any legal implications of signing this form?

    By signing the Alabama Central Registry Clearance form, the individual being checked agrees to authorize the release of information and waives any right to review or hearing they may otherwise have been entitled to concerning the information released. Furthermore, they release the Department of Human Resources and its officers and employees from any claims arising out of the release or dissemination of any information concerning themselves. It's crucial to understand these implications fully before signing the form.

Common mistakes

Filling out the Alabama Central Registry Clearance form is a critical step in ensuring the safety and well-being of children in various settings. However, mistakes can occur during this process. Below are common errors to avoid:

  1. Not using black or blue ink to fill out the form, as specified in the instructions, can lead to processing delays.

  2. Omitting the requesting person or agency/organization's information, including the mailing address and telephone number, can result in a lack of communication.

  3. Forgetting to check all applicable boxes that describe the requester's affiliation, such as Child Placing Agency or Residential Child Care Facility, can lead to an incomplete assessment.

  4. Not printing the requestor’s name clearly can create confusion over who is requesting the clearance.

  5. Leaving the specific job/role section blank or vague does not provide enough context for the nature of the unsupervised care and supervision being provided.

  6. Incorrect or incomplete personal information, including names, dates of birth, and mailing addresses of the person being cleared, can hinder the accuracy of the clearance process.

  7. Failing to list all aliases, maiden, and prior married names, as well as the names and DOBs of spouses, former spouses, and children can obscure potential records.

  8. Not mentioning all Alabama counties where the person has lived or worked limits the scope of the search, possibly missing crucial information.

In addition to these specific mistakes, it is essential to ensure that all required signatures and dates are provided. Moreover, it is vital to attach additional pages if necessary to furnish all requested details. By avoiding these common errors, individuals and organizations help support the Alabama Department of Human Resources' mission to discover or prevent child abuse and neglect.

Documents used along the form

The Alabama Central Registry Clearance form is an essential document utilized primarily by individuals and organizations involved in providing care or services to children. This form helps ensure that individuals working with or around children do not have a history of child abuse or neglect. However, to further secure the safety of children and comply with legal and procedural requirements, several additional forms and documents are often used alongside the Alabama Central Registry Clearance form. These documents cater to various aspects of background checks, employment, and safety protocols.

  • Background Check Authorization Form: This form is used to obtain permission from the individual to conduct a background check, which might include criminal history, employment history, and other relevant checks.
  • Employment Application Form: Organizations usually require a detailed employment application that provides comprehensive information about the applicant, including their education, employment history, references, and other pertinent details.
  • Drug Screening Consent Form: Many organizations mandate a drug test for potential employees. This form gets the consent of the individual to undergo drug testing.
  • Child Protection Policies Acknowledgement Form: Individuals are often required to read and acknowledge the child protection policies to ensure they understand the organization's commitment to safeguarding children and their responsibilities towards this commitment.
  • Reference Check Form: This form is used by employers to gather feedback from references provided by the applicant, offering insights into the applicant’s character, work ethic, and suitability for working with children.
  • Volunteer Agreement Form: For volunteers, this document outlines the terms and conditions of volunteer work, emphasizing the volunteer’s roles, responsibilities, and the organization’s expectations regarding conduct, especially around children.
  • Confidentiality Agreement Form: Individuals working with children might have access to sensitive information. This form ensures that they agree to keep this information confidential and understand the legal implications of breaching confidentiality.

Together with the Alabama Central Registry Clearance form, these documents form a comprehensive framework to help organizations maintain a safe environment for children. By thoroughly vetting all employees and volunteers through these forms and agreements, organizations can take proactive steps toward preventing child abuse and neglect, thereby ensuring the welfare and safety of children under their care.

Similar forms

  • FBI Background Check: This document, much like the Alabama Central Registry Clearance form, involves a process to check an individual's criminal history to ensure they are suitable for roles that involve the trust and safety of others, particularly children. While the FBI Background Check is broader, covering national criminal history, the Alabama clearance focuses specifically on child abuse and neglect within the state.

  • Child Protective Services (CPS) Clearance: Similar to the Alabama form, a CPS clearance checks for any history of child abuse or neglect but can vary in scope from one state to another. Both serve to protect children from potential harm by ensuring individuals in care roles have no history of causing such harm.

  • State Criminal Background Check: This document is akin to the Alabama Central Registry Clearance, as both involve screening an individual's background for red flags that may disqualify them from certain positions of trust. While the state criminal background check reviews broader criminal activity, the Alabama form is specifically concerned with child abuse and neglect.

  • Sex Offender Registry Check: This check, similar to the Alabama form, is designed to ensure the safety of vulnerable populations by screening individuals against sexual offender registries. While the sex offender registry check is focused on sexual offenses, the Alabama clearance encompasses all forms of child abuse and neglect.

  • Employee Disqualification List (EDL) Verification: Like the Alabama Central Registry Clearance form, EDL verification protects vulnerable populations by ensuring individuals have not previously engaged in activities that would disqualify them from employment in sensitive roles, including but not limited to harm against children or the elderly.

  • Foster Care Licensing Background Check: This check parallels the Alabama clearance by specifically evaluating individuals' suitability to foster care roles. Both documents aim to protect children from abuse and neglect, ensuring a safe living environment for the most vulnerable.

  • Professional Licensing Background Checks: Similar to the Alabama Central Registry Clearance form, these checks are necessary for obtaining professional licenses in fields that involve working with children or vulnerable populations, ensuring that individuals have no history of harmful behavior that would make them unsuitable for such roles.

Dos and Don'ts

When completing the Alabama Central Registry Clearance form, particular attention to detail and the manner of submission are paramount to ensuring a smooth processing experience. Below are pertinent do's and don'ts to consider:

Do:
  • Use black or blue ink: The form specifically requests that it be completed in black or blue ink to ensure clarity and legibility.
  • Print or type clearly: This facilitates the accurate reading and processing of your submission by the Department of Human Resources.
  • Check all applicable boxes: Carefully review and mark all boxes that relate to your request or status to ensure the form is processed in the context of your specific circumstances.
  • Include accurate and thorough information: Double-check that all personal details, addresses, and additional information are correct and complete to avoid delays in processing.
  • Attach additional pages if needed: If more space is required to provide complete answers or elaborate on certain sections, don't hesitate to add extra pages.
  • Sign and date the form correctly: Your signature is a critical component, legally affirming the accuracy of the information provided and your consent for the registry check.
  • Review privacy waivers and authorizations carefully: Understand your rights and the implications of waiving them, as this form includes consent to release potentially sensitive information.
  • Keep a copy for your records: Before sending the form, make a copy for your personal records to have an account of what was submitted.
  • Use the correct address for submission: Refer to the instructions for the appropriate address, ensuring the form reaches the intended department or person.
  • Contact the Department for any clarifications: If any part of the form is unclear, directly reaching out to the Department can prevent mistakes and unnecessary delays.
Don't:
  • Use colors other than black or blue ink: Straying from the specified ink colors can cause issues with form legibility and processing.
  • Skip sections or boxes: Even if certain areas seem not to apply directly to you, review them meticulously to avoid incomplete submissions.
  • Forget to check the specific job/role box: Clearly indicating the capacity in which you'll be involved with children is essential for the form's purpose.
  • Misprint your personal information: Errors in personal details can lead to processing delays or incorrect assessments of your submission.
  • Submit without signing: An unsigned form is invalid and will not be processed.
  • Omit contact information: Failing to provide a way for the Department to reach you can stall the clearance process.
  • Ignore instructions on the back of the form: Valuable information regarding the submission process and contact details for assistance is often provided on the reverse side.
  • Provide incomplete information about past residences: Full disclosure of previous Alabama counties where you've lived or worked is necessary for a comprehensive check.
  • Neglect to list all aliases and maiden names: For a thorough search, any name under which records might exist should be included.
  • Assume immediate processing: Understand that these checks can take time and plan accordingly to prevent any impact on your plans or employment.

Misconceptions

Misconceptions abound when it comes to the Alabama Central Registry Clearance form. It's critical to demystify these misunderstandings for individuals and organizations alike.

  • The form is only for individuals working with children. Fact: While primarily used to screen those in child-related services, the form can also request background checks for various roles, including volunteers and those not directly working with children but are in an environment where children are present.

  • Submission in only black ink is allowed. Fact: The form instructions specify that it must be filled out in either black or blue ink, debunking the common belief that only black ink is acceptable.

  • Electronic submissions are permissible. Fact: Currently, the Alabama Department of Human Resources requires this form to be printed and mailed in, not submitted electronically, contrary to what some might believe.

  • All sections of the form must be filled out by the requestor. Fact: Part of the form is designated for completion by the Department of Human Resources after a search of the Central Registry is conducted, indicating that not all sections are for the requester's input.

  • Only Alabama residents can be checked through this form. Fact: While the check is for any person who has lived or worked in Alabama, this can include individuals who are currently residing out of state but have Alabama history.

  • Instant results can be expected. Fact: Given that the search is thorough and involves sensitive data, the process is not immediate and requires a waiting period for the Department of Human Resources to complete their search and response.

  • Signing the form waives all rights to privacy. Fact: The individual signing the form only waives their right to a review or hearing related to the release of information from the Central Registry, not all privacy rights.

  • Any organization can request a clearance. Fact: The form is specific about who can request a clearance, including child placing agencies, residential child care facilities, and specific types of daycare centers, among others, outlined on the form itself.

  • If no report is located, the individual is clear of any misdemeanors too. Fact: The registry search is specific to child abuse/neglect cases and does not cover other legal issues, such as misdemeanors or felonies unrelated to child abuse or neglect.

Understanding these nuances ensures that individuals and organizations are better informed about the process and requirements of the Alabama Central Registry Clearance form.

Key takeaways

Filling out and using the Alabama Central Registry Clearance form is a crucial step for individuals intending to work or volunteer in positions involving the unsupervised care and supervision of children. Below are six key takeaways to help navigate the process efficiently and accurately.

  • Complete the form using black or blue ink: This directive ensures that the information is legible and that the form can be processed without delays.
  • The form requires detailed information about the applicant, including name, sex, race, date of birth, current mailing address, and any alias or maiden names. This comprehensive data helps in accurately identifying individuals in the central registry.
  • Applicants must disclose their relationship to children by listing the names and dates of birth of spouses, former spouses, and children/stepchildren. This information contributes to the thoroughness of the registry check.
  • It's essential to list all Alabama counties where the applicant has lived and/or worked. This widens the scope of the search, ensuring a thorough review of any potential records in different locales.
  • The form requires the signature of the applicant and a witness, signifying consent for the Alabama Department of Human Resources to release information from the Child Abuse / Neglect Central Registry. By signing, applicants also waive their right to any review or hearing they may otherwise be entitled to, and release the Department and its employees from any claims related to the release of information.
  • If an individual is found to have a substantiated report of being responsible for child abuse or neglect, only information necessary to discover or prevent child abuse or neglect will be released. This underscores the form's role in protecting children while respecting the privacy and rights of the applicant.

Understanding and correctly filling out the Alabama Central Registry Clearance form is a critical step for those seeking roles that involve caring for children. It not only ensures the safety and well-being of Alabama's children but also helps organizations make informed decisions regarding potential employees or volunteers. Always follow the instructions carefully and provide complete and accurate information to facilitate a smooth process.

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