Jc Cbc 3 Form PDF Details

Are you looking for a way to maximize the tax benefits when filing your return this year? Have you heard of the Jc Cbc 3 form, but don't know what it is? The Jc Cbc 3 form is an essential part of Canadian taxation rules and by utilizing it correctly could potentially save you hundreds or even thousands of dollars. In this blog post, we'll look at exactly what the Jc Cbc 3 form is and how to use it to your advantage while filing taxes. Read on to find out more!

QuestionAnswer
Form NameJc Cbc 3 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesNYS, OMH, JC, Delaware

Form Preview Example

NYS Justice Center for the Protection of People with Special Needs

(Justice Center)

Criminal Background Check Unit 161 Delaware Avenue Delmar, NY 12054

Fax: 518-549-0464

Request for Staff Exclusion List Check Form

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. “Any person” can include an employee, administrator, consultant, intern, volunteer, or

contractor.

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.

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 (Please Print)

Last

 

First

 

MI:

Name:

 

Name:

 

 

 

 

 

Date of Birth:

Social Security Number:

Alien Reg#:

 

 

 

 

 

 

Applicant

 

Applicant type:

 

 

address:

 

 

 

 

 

 

 

 

Facility/Provider Name:

 

 

 

 

 

Address:

 

 

 

 

 

State Oversight Agency: OMH OPWDD OCFS DOH SED OASAS

Please circle appropriate agency(ies)

Part 2. Authorized Person Information

Please print clearly

Name: (Please Print)

Signature:

Facility/Provider

name:

Email:

Phone:

Address:

JC CBC 3 (7/13)