Navigating the intricacies of background checks and evaluations in the workforce can sometimes feel overwhelming, yet understanding them is crucial for both employers and potential employees. At the heart of these procedures is the Form 470-2310, a critical document for those who have faced criminal convictions, founded abuse charges, or similar issues. This form serves as a gateway for individuals seeking clearance to work, particularly in sensitive roles that involve the care and safety of others. It requires detailed information from both the requesting agency or employer and the individual undergoing the evaluation. The form not only asks for basic personal details and the specifics of the roles applied for but also dives deep into the nature of any past offenses. It prompts individuals to reflect and report on the circumstances surrounding each incident, their personal growth since then, and any rehabilitative steps they have taken. Moreover, it opens a channel for evaluating bodies like the Department of Human Services (DHS) to make informed decisions based on the completeness and honesty of the provided information. The inclusion of a section for the agency's final determination emphasizes the form's role in facilitating a thorough and transparent evaluation process, ensuring that decision-makers have all the necessary context to assess an individual's suitability for their intended role responsibly.
| Question | Answer |
|---|---|
| Form Name | 470 2310 Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | iowa dhs record, record check evaluation iowa dhs, iowa zip rce, iowa dhs 470 |
Record Check Evaluation
A. Agency/Provider/Person Requesting Evaluation
Entity Requesting Evaluation
Requestor’s Name
Phone
Fax
Street
City
State
Zip Code
The agency/provider/person listed above is requesting a Record Check Evaluation (RCE) on the following person after a background check revealed a criminal conviction (or deferred judgment), founded abuse (child or dependent adult), or a combination thereof. In order to complete the evaluation, we need to have all information, including form
B. Person Being Evaluated
Last Name, First Name, Middle Initial |
Maiden/Previous Names |
Role/Position Applying For |
|
|
|
The individual listed above requests an evaluation to determine whether they can be permitted to perform duties under the section “Role/Position Applying For.”
I realize that the information I provide in Section D. may be verified with local law enforcement agencies, the district court, Iowa Department of Human Services, or other persons having knowledge of the incident.
Signature of Person Being Evaluated
Telephone
Date
Street Address
City
State
Zip Code
C. Evaluation Determination/Notice of Decision
FOR DHS USE ONLY
D.
Explain, in detail, each crime or abuse (completed by applicant). Include date, location, others involved, relationship of the victim to you, age of the victim, and your actions for each abuse or criminal history (additional sheets may be used).
What changes have you made to make you safe to work around or care for others? Explain your accomplishments; work history; caretaker history; counseling, therapy, parenting classes; etc. Supporting documents such as treatment certificates, reference letters from previous/current employers or probation officers should be included.
Has DHS evaluated you in the past? Explain when the previous evaluation occurred, what position you were applying for, and whether you received the job/position.