Form Jc Cbc 3 PDF Details

In the realm of safeguarding the rights and well-being of individuals with special needs, the JC CBC 3 form emerges as a pivotal document, aiding in the meticulous process of ensuring that those employed in positions of substantial and regular contact with vulnerable service recipients do not pose a risk. Crafted by the New York State Justice Center for the Protection of People with Special Needs, this form serves a unique purpose, especially designed for applicants who have not been assigned a Social Security Number or Alien Registration Number. Unlike the more routine online checks, this fax-only submission underscores the Center's commitment to inclusivity and thoroughness in background evaluations. Central to this system is the Vulnerable Persons Central Register (VPCR), which houses the Staff Exclusion List (SEL)—a database of individuals found to have committed serious acts of abuse, rendering them ineligible for such employment. The instructions delineate a structured procedure whereby an authorized person from a provider organization submits this form, evidencing serious consideration of an applicant's candidacy for a role entailing significant interaction with service recipients. The form is not merely a step in the hiring process but a rigorous safeguard, with the Justice Center’s Criminal Background Check (CBC) unit playing a critical role in conveying the outcome of the SEL check. Importantly, an applicant's presence on the SEL prompts a mandatory exclusion from employment in specific roles, while for others, it grants discretion in hiring, underscoring the nuanced approach taken to protect vulnerable populations. Moreover, the JC CBC 3 form incorporates a comprehensive contingency for applicants not listed on the SEL, directing further criminal background checks and inquiries into the Statewide Central Register of Child Abuse and Maltreatment, thereby fortifying the safety net around those at risk. This integrated approach, facilitated through the JC CBC 3 form, exemplifies a steadfast commitment to the dual goals of justice and protection, ensuring that the privilege of working closely with special needs individuals is reserved for those who pose no threat.

QuestionAnswer
Form NameForm Jc Cbc 3
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesSSN, OCFS, staff exclusion list form fillable, VPCR

Form Preview Example

Request for Staff Exclusion

List

Check Form

For FAX only submission

NYS Justice Center for the Protection of People with Special Needs (Justice Center)

Criminal Background Check Unit Fax: 518-549-0464

THIS FORM IS ONLY TO BE USED WHEN AN APPLICANT HAS NOT BEEN ISSUED A SOCIAL SECURITY NUMBER OR ALIEN REGISTRATION NUMBER. All other Staff Exclusion List checks should be done online. Please direct any questions to cbc@JusticeCenter.ny.gov

The Justice Center maintains a Vulnerable Persons Central Register (VPCR) that includes a Staff Exclusion List (SEL) containing the names of individuals who have committed serious acts of abuse and are deemed ineligible to work in a position involving regular and substantial contact with a service recipient. Providers must request the Justice Center to conduct a check of the SEL before determining whether to hire or otherwise allow any person to have regular and substantial contact with a service recipient.

Instructions:

1.The provider’s Authorized Person must complete this form and fax it to the Justice Center’s Criminal Background Check (CBC) unit for an applicant under serious consideration to be hired or otherwise permitted to have regular and substantial contact with a service recipient.

This form should not be used as a screening tool for all applicants.

2.The Justice Center’s CBC unit will send the Authorized Person an email indicating the results of the SEL check.

3.If the Applicant is on the SEL, he or she may not be hired in a position involving regular and substantial contact with a service recipient in a facility or provider agency defined in

Social Services Law §488(4) or by other providers of services in programs licensed or certified by the Office of Mental Health, Office for People With Developmental Disabilities, Office of Alcohol and Substance Abuse Services, Office of Children and Family Services, Department of Health and State Education Department.

4.If the Applicant is on the SEL, certain other providers have discretion whether to hire the individual as provided in Social Services Law §495(3).

5.If the Applicant is not on the SEL, a criminal background check through the Justice Center, if required, and an inquiry of the Statewide Central Register of Child Abuse and Maltreatment

through the Office of Children and Family Services, if required, must be conducted.

Part 1. Applicant Information

Last Name:

First Name:

Job title:

 

Date of Birth:

 

Only if no SSN or Alien Reg. is available

Facility/Provider

 

Name & Address:

 

MI:

Oversight Agency:

OMH OPWDD DOH SED OASAS OCFS

(Please check one)

 

Part 2. Authorized Person Information

Name:

Work Email Required

Facility/Provider

Name:

Phone:

JC CBC 3 (7/14) Made Fill-able by DM

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