OCFS-4930 Form PDF Details

In the realm of ensuring safety and integrity within environments catering to children and families, the OCFS-4930 form plays a vital role. This document, a product of the New York State Office of Children & Family Services, is a critical requirement for individuals seeking to engage in roles that necessitate interaction with children in settings such as foster care, adoption, and child day care. To proceed with fingerprinting services, which are a prerequisite for such positions, the applicant is required to complete this form meticulously. It encompasses essential information including personal identifiers, role designation within the child care framework, and specific details relevant to the foster care and adoption sectors. Additionally, it outlines the process for scheduling a fingerprinting appointment and the specific types of identification that must be presented. Covering a broad spectrum of roles from directors and providers to household members over 18 years old, the form ensures a standardized method for conducting background checks, thus fortifying the security protocols within these sensitive environments. Moreover, it serves as a bridge between applicants and the necessary fingerprinting services, facilitated through designated contact points including a website and a call center, making the process as accessible and streamlined as possible.

QuestionAnswer
Form Name OCFS-4930 Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names ocfs form 4930, nys fingerprinting for child care, ocfs 4930 form, ocfs fingerprint form

Form Preview Example

OCFS-4930 (8/2009)

NEW YORK STATE

OFFICE OF CHILDREN & FAMILY SERVICES

REQUEST FOR NYS FINGERPRINTING SERVICES

INFORMATION FORM

(To be completed by Provider or Foster Care/Adoption Agency)

Enrollment Information:

Applicant must have an appointment to be fingerprinted. At appointment, applicant will need to bring this form and acceptable ID as noted on reverse.

Appointments can be obtained by contacting vendor at one of the following:

Website: www.L1Enrollment.com or the Call Center: 877-472-6915

Contributor Agency Section:

ORI:

NY922130Z

 

 

 

Contributor

 

 

 

NYS Office of Children & Family Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child Day Care

 

 

 

 

 

 

 

 

 

 

 

 

Job or License Type:

 

 

 

Foster Care/Adoption

Mentor

 

 

 

 

 

 

OCFS Employee (employee / peace officer – please circle one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Facility/Agency ID Number: 39491

 

 

 

 

Additional Agency ID Info:

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(FOSTER CARE/ADOPTION ONLY)

Facility Name/Address: Holy Cross Head Start, Inc. 150 Maryland St. Buffalo, NY 14201

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant Section:

 

 

 

 

 

New Submission

 

 

 

Resubmission

 

 

 

 

 

 

 

Name of Applicant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alias / Maiden Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, & Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

Sex:

Male

Female

Other Ethnicity:

Hispanic

Non Hispanic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race:

 

White

Black

American Indian/Alaskan Native

Asian/Pacific Islander

 

 

 

 

Other

 

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Skin Tone:

 

 

 

 

 

 

 

 

Eye Color:

 

 

 

 

Hair Color:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Height:

 

 

 

 

 

 

ft

 

 

 

 

 

 

in

Weight:

 

 

 

 

 

lbs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State / Country of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Role of Applicant (please check one):

CHILD DAY CARE:

FOSTER CARE:

ADOPTION:

Director

Provider

Employee/Teacher/Volunteer

Household Member over 18 yrs

Foster Parent

Relative Foster Parent

Household Member over 18 yrs

Foster Child

 

 

 

 

Adoptive Parent

Household Member over 18 yrs

 

Additional Information: (Foster Care Only)

CONNECTIONS Home Resource ID# N/A CONNECTIONS Person ID# N/A

DCJS (Rev. 8 – 8/09)

OCFS-4930 (8/2009)

Accepted Forms of Identification:

NOTE: Applicant MUST present two (2) forms of ID, at least one of which must have a photo (see Column A):

Column A - Valid Photo Identification:

Column B - Valid Supplementary Identification:

U.S. Passport (unexpired or expired)

Voter registration card

Permanent Resident Card

U.S. Military card or draft record

Alien Registration Receipt Card

Military dependent’s ID card

Unexpired Foreign Passport

Coast Guard Merchant Mariner Card

Driver’s License or Photo ID Card

Native American Tribal Document

(issued by U.S. State or Territory)

Canadian Driver’s License

School or College ID Card (with photo)

U.S. Social Security Card

Unexpired Employment Authorization

Original or certified copy of a Birth Certificate

with photo (Form I-766, I-688, I-688A or B)

issued by authorized U.S. agency with official seal

Photo ID Card issued by federal, state, or local govt.

Certification of Birth Abroad (issued by U.S.

 

Department of State)

 

U.S. Citizen ID Card (Form I-7)

 

 

Identification if under 18 and nothing else available:

School record or report card

Clinic, doctor, or hospital record

Enrollment Website address: www.L1Enrollment.com

Call Center phone number: 877-472-6915

DCJS (Rev. 8 – 8/09)

How to Edit OCFS-4930 Form Online for Free

In case you want to fill out new york state ocfs forms, you won't need to install any software - just give a try to our PDF editor. FormsPal team is dedicated to providing you the absolute best experience with our editor by regularly presenting new features and improvements. Our tool is now even more user-friendly as the result of the latest updates! At this point, filling out documents is a lot easier and faster than ever. All it requires is just a few simple steps:

Step 1: Press the "Get Form" button at the top of this page to get into our editor.

Step 2: Using our advanced PDF tool, it is possible to accomplish more than simply complete blanks. Edit away and make your documents appear professional with custom textual content added, or modify the original content to excellence - all backed up by an ability to add almost any pictures and sign the document off.

As a way to finalize this PDF form, be sure you provide the necessary information in each and every blank field:

1. Start completing your new york state ocfs forms with a selection of necessary blanks. Get all of the necessary information and make certain nothing is left out!

Step # 1 in filling out ocfs fingerprinting

2. Soon after completing the previous step, go on to the next step and fill out the necessary particulars in all these fields - Identification if under and, and Call Center phone number.

Writing segment 2 of ocfs fingerprinting

A lot of people generally get some points wrong while filling in Identification if under and in this area. Ensure that you read twice whatever you enter here.

Step 3: Revise all the information you've entered into the form fields and press the "Done" button. Join us now and easily use new york state ocfs forms, set for downloading. Every last edit made is handily kept , letting you edit the form at a later stage when necessary. FormsPal offers protected document editing devoid of personal information recording or any type of sharing. Feel at ease knowing that your details are secure with us!

OCFS-4930 Form isn’t the one you’re looking for?

Related Documents