Form CFS 718-B – Fill Out and Use This PDF

The CFS 718-B form, issued by the Illinois Department of Children and Family Services, serves as an authorization for background checks for individuals aiming to work, volunteer, live in, or operate a child care facility. It is a comprehensive form that requires detailed personal information, history of residences, and consent for checking criminal and child abuse records. To ensure a safe environment for child care, it's crucial that anyone involved in child care services accurately completes and submits this form. Ready to take the next step? Click the button below to fill out your form.

Get Form Now Download PDF

Form CFS 718-B PDF Details

The CFS 718-B form, a critical document created by the Illinois Department of Children and Family Services, stands as a gateway for individuals aspiring to operate within the realms of child care or take part in the lives of children through various capacities such as employment or volunteering. This comprehensive document not only facilitates a background check that is vital for the safety and well-being of children but also categorically outlines the various roles and establishments it applies to—ranging from unlicensed day care homes to more formal child welfare agencies. Individuals over the age of 13 seeking to engage with child care facilities are required to fill out this form, providing detailed personal information including past addresses, employment history, and more, thereby enabling a thorough vetting process. Furthermore, it mandates the authentication of the applicant's identity and legal standing in child-related offenses and other criminal activities, thus ensuring that candidates are scrutinized under stringent safety norms. The authorization section reinforces the applicant’s consent for the Department to conduct an in-depth investigation, which is not only limited to checking criminal records but also includes examining child abuse and neglect reports. Accuracy and honesty are underscored as essential, with the reminder that any falsification of information may lead to denial or termination associated with their role in child care. This form, therefore, symbolizes a critical step in safeguarding the integrity of child care services and the collective effort to ensure a safe environment for children.

Question	Answer
Form Name	Form CFS 718-B
Form Length	4 pages
Fillable?	Yes
Fillable fields	115
Avg. time to fill out	24 min 4 sec
Other names	718b dcfs form, 718 b, illinois authorization background check, illinois authorization care form

Form Preview Example

CFS 718-B

Rev 12/2015			Illinois Department of Children and Family Services
Rev 12/2015
		AUTHORIZATION FOR BACKGROUND CHECK for Child Care
		READ INSTRUCTIONS ON REVERSE SIDE AND PRINT ALL INFORMATION

	CHECK ONE BOX IN EACH COLUMN IN EITHER ROW A or B:
		Category of Facility	Specific Type of Application	Person in the Home/Facility

				Applicant
		Child Care in the Home	Unlicensed Day Care Home	Member of Household (ages 13 to 17)*
		Child Care in the Home	Unlicensed Day Care Home	*Parent/Guardian signature required
	A	Unlicensed/Licensed/	Day Care Home	*Parent/Guardian signature required
1		Unlicensed/Licensed/	Day Care Home	Member of Household (age 18 and over)
		Applying for	Group Day Care Home

				Employee/Volunteer
				Employee/Volunteer
				Ward
		Child Care Facility	Youth Emergency Shelter	Applicant/Operator (Person applying to operate
		(other than a home)	Child Welfare Agency	a licensed child care facility)
		(other than a home)	Group Home	a licensed child care facility)
	B	Exempt/Licensed/	Day Care Center	Executive Director
		Exempt/Licensed/	Child Care Institution/Maternity Center
		Applying for	Day Care Agency	Employee/Volunteer
		Applying for	License Exempt Facility

PERSONAL INFORMATION (Please see additions instructions on the back page)

Last Name/First Name/Middle Initial

Social Security or ITIN Number

Maiden and/or Any Names Formerly Used (Last/First/Middle Initial)

__ __ __ - __ __ - __ __ __ __

List all previous addresses for the past five (5) years,

including those outside of Illinois.

Dates

(Street/Apt.#/City/County/State/Zip Code)

From/To

CURRENT ADDRESS, TELEPHONE (when applicable):

Street/Apt.#:

City:

State:

__ __

Zip Code: __ __ __ __ __

County:

Home Telephone ( __ __ __ )

__ __ __ - __ __ __ __

Cell Phone ( __ __ __ )

__ __ __ - __ __ __ __

Have you lived outside of Illinois in the past 3 years?

Yes

Date of Birth

Age

Place of Birth

Citizenship (Country)

Gender

Height

Weight

Hair

Eye

(Month/Date/Year)

(City and State)

USA

Ft. In.

(lbs.)

(color)

Other Specify

Race (Check all that apply)

Ethnicity

Native American/Alaskan (Indian or Eskimo)

Black/African American

White

Declined to Identify

(see codes on Page 2)

Asian

Native Hawaiian/Pacific Islander

Unknown

Could not be Verified

AUTHORIZATION /CERTIFICATION

Have you ever been indicated as perpetrator in a child abuse/neglect investigation?

Yes

Have you ever been convicted of a criminal offense, other than a minor traffic violation?

Yes

I certify that I have read and understood the Authorization/Certification box on the back page of this form.

SIGNATURE

DATE

Parent/Guardian Signature (if applicable)

DATE

TO BE COMPLETED BY SUPERVISING AGENCY

This authorization will not be processed without completion of this section. The licensing representative or child’s worker must complete the following

Date Fingerprinted:

Supervising Agency Name:

Provider ID#

Full Name of Facility

Provider ID #

DCFS Region/Site/Field

Street Address:

Name of Worker

Worker ID#/Phone Number

City

IL ZIP:

Name of Supervisor

Supervisor ID#/Phone Number

BACKGROUND RESULTS AS APPLICABLE

FOR CENTRAL OFFICE OF LICENSING USE

Sex Offender Clearance:

CANTS Clearance:

SID#

Clear

Record

BC-03 Registered:

Illinois State Police Clearance:

FBI Clearance:

FBI Sent Out:

Transfer Clearances: SO/CANTS:

ISP:

WHO SHOULD USE THIS FORM: This form must be completed by every person age 13 or older as part of an application to operate or reside in a child care facility, or be employed by or volunteer at a day care or group day care home. Every person subject to a background check must complete the first three sections identifying the type of facility and what role they will have at the facility and all personal information. All identifying information must be accurate and complete. The Parent or Guardian’s signature is required if background check is for a minor.

	ADDITIONAL INSTRUCTIONS FOR SECTIONS 2 AND 3 OF THE FRONT PAGE

Name:	Current and all former names used by the individual must be included. If no other names, write “none.”

Social Security,	THIS FORM WILL NOT BE PROCESSED WITHOUT A COMPLETE SOCIAL SECURITY, INDIVIDUAL
ITIN or Assigned #.	TAXPAYER IDENTIFICATION (ITIN) NUMBER OR DEPARTMENT ASSIGNED NUMBER

Address:	Current and all addresses, including county, where the person has lived in the past five years (Indicate if outside of Illinois)

Race:	Enter all race codes that apply.
	NA	=	Native American/Alaskan (Indian or Eskimo)	WH	=	White
	AO	=	Asian	UK	=	Unknown
	BL	=	Black/African American	DI	=	Declined to Identify
	PI	=	Native Hawaiian/Pacific Islander	CV	=	Could not be Verified

Ethnicity:	Enter the primary Ethnicity
	NH	=	Not Hispanic (NONE)	HA	=	Hispanic Central American
	HS	=	Hispanic South American	HN	=	Hispanic Dominican
	HM	=	Hispanic Mexican	HO	=	Hispanic Other
	HP	=	Hispanic Puerto Rican	UK	=	Unknown
	HD	=	Hispanic Spanish Descent	DI	=	Declined to Indentify
	HC	=	Hispanic Cuban	CV	=	Could not be Verified

ADDITIONAL INSTRUCTIONS FOR SECTIONS 4 OF THE FRONT PAGE

Instruction for Left Side -

Name of Facility:	The full name which appears on the license application or the
	license. (DO NOT USE ACRONYMS)
Provider ID #:	The Provider ID. (The number which appears on the license
	certificate for the facility. Initial Applications will be assigned #
	by Background Check Unit.)
Street/City/Zip:	The site of licensed facility where person is licensed or
	employed.

Instructions for Right Side –

Supervising Agency:	Print the name and Provider ID# of Agency which
	will supervise the facility
Provider ID #:
DCFS Region/Site/field:	The DCFS Region/Site/Field.
Name of the
Worker:	Name, ID and phone of the worker
Name of the
Supervisor:	Name, ID and phone of the supervisor

The Authorization for Background Check must be submitted to the worker for completion of Section 4 and for forwarding to the DCFS pertinent Background Check Unit. The worker must check the form for completeness and accuracy, confirm that the person (if age 18 or older) has been fingerprinted, and verify the correct spelling of names alongside a form of identification, such as a driver’s license or photo ID.

AUTHORIZATION/CERTIFICATION

I authorize the Illinois Department of Children and Family Services to conduct an investigation to determine whether I have ever been charged with a crime and, if so, the disposition of those charges. I authorize the Department to request information and assistance from the U.S. Justice Department and the Illinois Department of Law Enforcement in the conduct of this investigation. I authorize the Department to periodically search child abuse and neglect reports to determine whether I have been a perpetrator of an “indicated” incident of child abuse or neglect pursuant to the Abused and Neglected Child Reporting Act. The child abuse and neglect background check and the criminal history investigation may be used for considering an application for license, current or prospective employment, or service as a volunteer in a child care facility. Persons 13-17 years of age signing this form authorize a search of CANTS and LEADS only and are not subject to fingerprinting.

I understand that information obtained as a result of my authorizing this investigation is confidential but may be shared with my employer, prospective employer, the licensing applicant for whom my background check is required or with authorized licensing staff in accordance with applicable state and federal law and DCFS Regulations. I further certify that the information provided on this form is true and correct. I acknowledge that falsification of any information provided above and/or the results of the background check may be full and sufficient grounds to deny the application for licensure or may result in the termination of my employment.

Should you feel that the information on your Illinois State Police record or Federal Bureau of Investigation record is incorrect you may visit: http://www.ilga.gov/commission/jcar/admincode/020/02001210sections.html for the ISP and http://www.fbi.gov for FBI.

How to Edit Form CFS 718-B Online for Free

il background check form can be completed without any problem. Just make use of FormsPal PDF editor to perform the job fast. In order to make our editor better and simpler to use, we constantly come up with new features, with our users' feedback in mind. Starting is effortless! Everything you should do is follow the next easy steps down below:

Step 1: First, access the editor by pressing the "Get Form Button" at the top of this page.

Step 2: As soon as you access the PDF editor, you will find the form all set to be filled in. In addition to filling out different blanks, you could also do other things with the file, including writing your own textual content, modifying the initial textual content, inserting images, placing your signature to the form, and a lot more.

This document will need specific details; in order to guarantee accuracy and reliability, remember to take heed of the recommendations further down:

1. It is crucial to fill out the il background check form correctly, so be mindful when working with the areas including all these fields:

dcfs 718 b completion process shown (stage 1)

2. Once the last selection of blank fields is completed, go to enter the relevant details in these: Home Telephone, Cell Phone, Date of Birth, MonthDateYear, Age, Place of Birth City and State, Have you lived outside of Illinois, Yes, Citizenship Country, Gender, USA, Other Specify, Height Ft In, Weight lbs, and Hair.

You can certainly make an error while filling out the Home Telephone, consequently ensure that you go through it again before you send it in.

Step 3: Check that your information is accurate and then click "Done" to continue further. Go for a free trial plan with us and get direct access to il background check form - which you'll be able to then work with as you wish in your personal account. We don't share or sell the details you provide while completing forms at FormsPal.

Form CFS 718-B – Fill Out and Use This PDF

Form CFS 718-B PDF Details

Form Preview Example

How to Edit Form CFS 718-B Online for Free

Form CFS 718-B isn’t the one you’re looking for?

Related Documents