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How do I fill this out?
To fill out the CHRC request form, gather all required information about the subject individual. Ensure that the Authorized Person completes the form accurately, signing in Section 3. Review all details for completeness before submission.
How to fill out the Request for Criminal History Record Check Instructions?
1
Collect necessary documents and identification for the subject.
2
Complete all sections accurately before submission.
3
Have the Authorized Person sign and date the form.
4
Submit the form along with the fingerprinting results.
5
Keep a copy of the submitted form for your records.
Who needs the Request for Criminal History Record Check Instructions?
1
Healthcare facilities require this form for employee background checks.
2
Home health agencies use this document to comply with state regulations.
3
Licensed care service agencies need it for hiring qualified staff.
4
Educational institutions may require this for staff working with children.
5
Staffing agencies use this form to verify the background of their employees.
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What are the instructions for submitting this form?
Submit the completed CHRC form via mail to the DOH CHRC Unit at P.O. Box 2607, Albany, NY 12220-0607. You may also fax the form to 518.474.7477. Email submissions can be sent to chrc@health.state.ny.us for electronic processing where applicable.
What are the important dates for this form in 2024 and 2025?
Important dates related to the CHRC form include potential annual updates to regulations and submission deadlines by agencies. Ensure to check for any changes affecting submission practices in 2024 and 2025. Staying informed will help maintain compliance with state laws.
What is the purpose of this form?
The purpose of this form is to ensure that agencies can adequately vet their employees who will provide care to vulnerable populations. This process helps protect the safety and well-being of individuals receiving care and services. By verifying criminal history, agencies can make informed hiring decisions.
Tell me about this form and its components and fields line-by-line.
- 1. Social Security Number: Required for identity verification.
- 2. Date of Birth: Necessary for age verification and background checks.
- 3. Last Name, First Name, Maiden Name: Subject's full legal names for accurate identification.
- 4. Address: Subject's residing address, including city and zip.
- 5. Sex: To denote the individual’s gender.
- 6. Race: To provide demographic information.
- 7. Height: Subject's height in feet and inches.
- 8. Weight: Subject's weight in pounds.
- 9. Hair and Eye Color: To assist with visual identification.
- 10. Agency Identification: Information about the agency requesting the check.
What happens if I fail to submit this form?
Failure to submit the form correctly can result in significant delays in processing criminal history checks. Agencies may not be able to employ individuals until the check is completed. Ensuring accuracy and completeness is crucial for permit and service provision.
- Delayed Processing: Incomplete forms may cause significant delays in obtaining background checks.
- Compliance Issues: Failure to properly submit may result in non-compliance with state regulations.
- Employment Delays: Inaccurate information can prevent timely hiring of personnel.
How do I know when to use this form?
- 1. Hiring for Healthcare Roles: Required for all potential hires in healthcare to ensure safety.
- 2. Volunteers in Vulnerable Environments: Used for volunteers working with children or elderly individuals.
- 3. Contractor and Staffing Services: Utilized by staffing agencies to vet temporary employees.
- 4. Educational Institutions: Schools require background checks for staff who work with minors.
- 5. Licensing Requirements: Certain licenses may require proof of a background check.
Frequently Asked Questions
What is the purpose of the CHRC form?
The CHRC form is used to request a criminal history record check for employees in authorized agencies.
Who can complete this form?
The form must be completed by an Authorized Person on behalf of the agency.
What identification is required?
Two forms of ID, one of which must be government-issued with a signature.
Can I edit the CHRC form on PrintFriendly?
Yes, you can easily edit the PDF on PrintFriendly using our editing tools.
How do I submit the CHRC form?
The completed form must be forwarded to the DOH CHRC Unit at the specified address.
What happens if I provide inaccurate information?
Inaccurate or incomplete information may delay the processing of your request.
Is there a deadline for submitting this form?
There are no strict deadlines; however, timely submission is recommended for prompt processing.
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You can download the edited PDF to your device for your records.
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You can generate a shareable link or send it directly via email from PrintFriendly.
What is the significance of the fingerprinting method?
The fingerprinting method verifies the identity of the subject individual during the background check process.
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