CFS 508-1 Form PDF Details

In the realm of child care and welfare, the transparency and scrutiny in employee selection processes are of paramount importance to ensure the safety and well-being of children under professional care. The State of Illinois, recognizing this crucial need, has established comprehensive protocols for background checks and record-keeping through the implementation of forms such as the CFS 508-1. Revised in December 2013, this document serves a critical function by collating exhaustive information about individuals employed in child care facilities. The form is meticulously structured to gather details starting from the basic identification data of the employing facility and the employee, extending to vital segments that cover previous employment, direct and indirect experiences with children, educational background, and health clearances. Furthermore, it mandates an employer's certification, indicating a thorough validation of the employee's qualifications, and alignment with the Department of Children and Family Services' standards. This form, when attached to the CFS 508 and submitted to a DCFS licensing representative, acts as a cornerstone document ensuring that every person working in a child care role has undergone rigorous evaluation, thereby reinforcing the safety nets around children in institutional care settings.

QuestionAnswer
Form Name CFS 508-1 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names 508 1 cfs form, 508 1, 508 form dcfs, dcfs form 508

Form Preview Example

CFS 508-1

Rev. 12/2013State of Illinois

Department of Children and Family Services

Date Submitted

INFORMATION ON PERSON EMPLOYED IN A CHILD CARE FACILITY*

I.

Employing Facility

 

 

 

 

 

Facility Provider ID#

 

 

 

 

Address

 

 

 

 

 

 

(Street and Number)

 

(City)

 

(Zip Code)

II.Person Employed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Date of Birth)

 

Social Security Number

-

 

 

 

 

-

 

 

 

 

 

 

 

 

 

Phone

 

Home Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Street and Number)

 

 

 

 

 

 

 

(City)

 

 

 

 

(Zip Code)

III.

Employment

 

 

Date Employed:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position for which employed (Check appropriate item):

Executive, Superintendent, or Director Child Care Supervisor (child care institution) Child Care Worker (child care institution) Child Care Staff (group home)

Child Welfare Supervisor (child welfare agency)

Child Welfare/Licensing Worker (child welfare agency) Registered Nurse

Teacher (residential facility)

Housekeeping

Licensed Practical Nurse (day care center only) Early Childhood Teacher (day care center) School-age Worker (day care center)

Early Childhood Assistant (day care center) School-age Assistant (day care center) Substitute

Cook

Clerical

Other:

IV.

Previous Employment (Last ten years of employment)

 

 

From

To

Name and address of Employer

Type of Work and Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The employer, or authorized official of the employing facility has contacted the human resources personnel, management or knowledgeable supervisor for each listed previous employer to inquire about the employee’s work performance and whether the employee would be eligible for rehire.

NOTE: ATTACH THIS FORM TO THE CFS 508 AND SUBMIT IT TO YOUR DCFS LICENSING REPRESENTATIVE

V.Other Direct, Unpaid Experience with Children (Such as scout work, Sunday School teacher)

Report of Reference on File (At least three character and/or business, from persons not related to the employee)

Name of Reference

Address

Relationship

VI. Educational Background (Circle the one item indicating highest grade completed)

Elementary Grade:

High School:

GED:

0 1 2 3

4 5 6 7 8

1 2 3 4

Yes

Years of College (Undergraduate):

Years of Graduate Work:

 

1

2 3 4

 

1 2 3

4

 

No

College Degree:

 

Graduate Degree:

 

 

 

 

Name of School, College, or University last attended:

Other Special Training or Professional License (Specify):

Professional License Number:

Evidence of Educational Achievement on File:

Yes

VII. Physical Examination

Last Examination (Date):

Name and Address of Examining Physician:

No(Explain)

Health Clearance Report on File?

Yes

No

 

(Explain)

VIII. Certification of Employment

I, the employer, or authorized official of the employing facility, do hereby certify that the above-named person is employed in the position indicated and that, to the best of my knowledge is qualified for the position indicated, and employment is in accordance with minimum standards prescribed by the Department of Children and Family Services.

Signed:

Executive Director/Director:

How to Edit CFS 508-1 Form Online for Free

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In order to fill out this form, make sure that you type in the necessary information in each blank field:

1. The form 508 1 will require certain details to be typed in. Make certain the subsequent fields are finalized:

The best ways to fill out cfs 508 stage 1

2. Soon after filling in the previous section, go to the next step and enter the necessary particulars in these blank fields - Position for which employed Check, Executive Superintendent or, Licensed Practical Nurse day care, Child Care Supervisor child care, Early Childhood Teacher day care, Child Care Worker child care, Schoolage Worker day care center, Child Care Staff group home, Early Childhood Assistant day care, Child Welfare Supervisor child, Schoolage Assistant day care center, Child WelfareLicensing Worker, Substitute, Registered Nurse, and Teacher residential facility.

Stage # 2 of filling in cfs 508

3. The following portion is about The employer or authorized, and NOTE ATTACH THIS FORM TO THE CFS - type in every one of these empty form fields.

How one can prepare cfs 508 part 3

4. Filling in Other Direct Unpaid Experience, Report of Reference on File At, Name of Reference, Address, Relationship, GED, Yes, High School, Educational Background Circle the, and Years of Graduate Work is paramount in this next step - you'll want to take the time and fill out each and every blank!

Step number 4 of filling out cfs 508

Concerning Name of Reference and Address, make sure you review things here. Both these could be the key ones in the file.

5. This form has to be finalized with this part. Here there is a full set of fields that need to be filled in with specific details to allow your form usage to be accomplished: VII, Explain, Explain, Educational Background Circle the, Graduate Degree, Yes, Physical Examination Last, Yes, VIII Certification of Employment, and I the employer or authorized.

Completing part 5 of cfs 508

Step 3: Spell-check everything you have entered into the form fields and click the "Done" button. After setting up afree trial account at FormsPal, you'll be able to download form 508 1 or send it via email promptly. The PDF document will also be easily accessible in your personal account menu with your changes. FormsPal ensures your information privacy by having a protected method that never saves or distributes any personal data provided. You can relax knowing your docs are kept safe whenever you use our editor!

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