Alabama Central Registry Clearance PDF Details

In ensuring the safety and welfare of children, various measures and procedures have been implemented by states across the U.S. Among these, the Alabama Department of Human Resources provides a crucial tool in the form of the Child Abuse/Neglect (CA/N) Central Registry Clearance form. Aimed at preventing child abuse and neglect, this form is a mandatory step for individuals seeking to work in positions that involve the unsupervised care and supervision of children, whether as employees or volunteers. The form requires detailed personal information from the applicant, including their name, sex, date of birth, mailing address, and any alias or maiden names, as well as information about family members. It also requires the disclosure of any counties in Alabama where the applicant has lived or worked, ensuring a thorough background check can be conducted. Applicants must authorize the Alabama Department of Human Resources to release any information contained in the Child Abuse/Neglect Central Registry that pertains to them, waiving their right to any review or hearing related to the release of this information. This clearance process is not only a prerequisite for working in various child-related settings such as child placing agencies, residential child care facilities, and day/nightcare centers but also serves as a protective barrier, aiming to ensure that children are placed in safe environments, free from individuals with a history of child abuse or neglect.

QuestionAnswer
Form NameAlabama Central Registry Clearance
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesca n central registry clearance alabama, dhr can report, Stepchildren, alabama child abuse registry

Form Preview Example

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)

How to Edit Alabama Central Registry Clearance Online for Free

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Step 1: Click on the "Get Form Here" button.

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To fill out the file, enter the details the platform will request you to for each of the following areas:

alabama child abuse registry spaces to consider

Enter the demanded particulars in the area Name DOB of Children, Alabama counties where person has, Attach additional pages as needed, To be completed by person being, I authorize the Alabama Department, Signature, Date, Signature of Witness, Date, To be completed by DHR, A search of the Alabama Child, Substantiated report ie indicated, Type Report, Physical Abuse, and Neglect.

Finishing alabama child abuse registry part 2

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