Out of State Registry Check (If you work for a child care in TN)
The overall background check process includes a check of any applicable out of state registries if the applicant has lived in another state during the last (5) years. Please see the instructions for completing the out of state registry check portion of the background check process below.
If an applicant for child care employment has lived in another state during the last five (5) years select the state(s) from the tabs at the top of the box with the corresponding first letter of the state for which you are searching and follow the instructions for each state in which the individual has lived. Submit the forms as instructed along with any required documentation. Each form may have different requirements. Most forms require a signature. Others may require a witness, original signatures, notarization, and some require a copy of the applicant's photo identification.
After the applicant has completed all applicable out of state forms, they are to send them - along with their completed Child Care Fingerprint Sample Registration/Criminal/Juvenile History & State Registry Review Disclosure form - to the Nashville Department of Human Services office. Note that California requires the applicant to send their completed California form directly to California. In this case, the applicant is also required to submit to the Nashville Department of Human Services office a copy of the California-addressed envelope in which the applicant mailed the California form to California as proof that the applicant mailed this form to California. Unless directions specify an original form is required, each applicant’s forms should be submitted to our office, together, by email: ccbackground.dhs@tn.gov or fax: 615-532-9956. Applicant’s having state forms that are required to be original should mail all of their paperwork to:
Tennessee Department of Human Services
Attn: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
The state of Tennessee covers all fees for Tennessee Department of Human Services fingerprinting and all out of state background checks that require a fee.
Commonly Used Acronyms
CAN = Child Abuse and Neglect Registry
N/A = Not Applicable
TBD = To Be Determined
VPR = Vulnerable Persons Registry (or equivalent)
Instructions:
Each state is categorized in alphabetical order in the box below. Please select a state(s) from the tabs at the top of the box with the corresponding first letter of the state(s) for which you are searching. Please be sure to read all information regarding your selected state as information can vary between states. Some states may return forms unprocessed if information is missing or unreadable. In addition to any required forms for other states, each applicant must submit a Child Care Criminal/Juvenile History & State Registry Review Disclosure Form.
Return any required forms to DHS via the options listed below:
Important Note: ONLY SEND FORMS WITH PERSONALLY IDENTIFIABLE INFORMATION USING A SECURE METHOD.
- FAX: 615-532-9956 This is a dedicated fax that goes directly to the registry check processing unit.
- MAILING ADDRESS: Tennessee Department of Human Services, ATTN: OIG - Background Unit, James K. Polk Building, 15th Floor 505 Deaderick Street Nashville, TN 37243
- EMAIL: Use the mailbox below for general communications about the background check process. DO NOT USE THE MAILBOX TO SEND PERSONALLY IDENTIFIABLE INFORMATION UNLESS YOU HAVE THE ABILITY TO SEND SECURE EMAIL. CCBackground.DHS@tn.gov
Additional Information:
As the volume of registry check requests to other states increases, other states may change their process/forms to better accommodate those requests. Therefore, we will update this information as needed to reflect any changes in the process. If you require additional information about the background check process, you can contact us via the dedicated phone line at: (615) 253-4170.
Alabama
Checklist: Alabama Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Alabama form: https://www.tn.gov/content/dam/tn/human-services/documents/AL_Form_1598.pdf
Please note the following when completing the Alabama form:
- Alabama requires the original form (not a copy, but originally written on in ink).
- Please make sure to include full name; ex. last name, first name, full middle name, no initials accepted
- Please make sure to include applicant’s job/role
- Please make sure to include date of birth for all spouse, former spouse, children and stepchildren listed
- Please make sure to include all Alabama counties where applicant lived, worked or attended school
- Alabama requires a witness signature
- Applicant and witness signature dates must match
Please do NOT send this form to Alabama. Please send the original form to TN DHS, and TN DHS will send it to Alabama.
Instructions
Mail a copy of the checklist, disclosure form and original Alabama form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Alaska
Checklist: Alaska Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Alaska form: https://www.tn.gov/content/dam/tn/human-services/documents/AK_Form_06-9437.pdf
Please do NOT send this form to Alaska. Please send it to TN DHS, and TN DHS will send it to Alaska.
Instructions
Email, fax or mail checklist, disclosure form and Alaska form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
American Samoa
American Samoa
Checklist: American Samoa Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
Please do NOT send this form to American Samoa. Please send it to TN DHS, and TN DHS will send it to American Samoa.
Instructions
Email, fax, or mail checklist, disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Arizona
Checklist: Arizona Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Arizona form: https://www.tn.gov/content/dam/tn/human-services/documents/Arizona.pdf
Please do NOT send this form to Arizona. Please send it to TN DHS, and TN DHS will send it to Arizona.
Instructions
Email, fax or mail checklist, disclosure form and Arizona form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant together, including the checklist.
______________________________________________________________________________________________________________
Arkansas
Checklist: Arkansas Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete both Arkansas forms: https://www.tn.gov/content/dam/tn/human-services/documents/AR_Form_APS-0001.pdf and https://www.tn.gov/content/dam/tn/human-services/documents/AR_Child_Maltreatment_Registry_Form.pdf
Please note the following when completing the Arkansas form:
- Have both Arkansas forms notarized
Please do NOT send these forms to Arkansas. Please send them to TN DHS, and TN DHS will send it to Arkansas.
Instructions
Email, fax or mail the checklist, disclosure form and both Arkansas forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant together, including the checklist.
______________________________________________________________________________________________________________
California
Checklist: California Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete California form: https://www.tn.gov/content/dam/tn/human-services/documents/California.pdf
Please note the following when completing the California form:
- Have California form notarized
- Make two copies of notarized California Child Abuse Central Index Self Inquiry Request form
- Keep original notarized California Child Abuse Central Index Self Inquiry Request form on file
- Applicant mails one copy of the notarized California Child Abuse Central Index Self Inquiry Request form directly to California with their return address on the envelope
Please Note: Do not send the TN Disclosure form – only send the California Abuse Central Index Self Inquiry Request form. Otherwise, California will reject the request.
Instructions
Email, fax or mail the checklist, disclosure form, copy of notarized California Child Abuse Central Index Self Inquiry Request form and copy of envelope the California form was mailed to California in to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Please Note: Email, fax or mail a copy of the California results to our office, as soon as possible, after they have been received.
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms for each applicant together, including the checklist.
______________________________________________________________________________________________________________
Colorado
Checklist: Colorado Checklist
Form: for CAN and Criminal
- Colorado requires that the form be typed
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- At the bottom of page 2 in Section B, on the Colorado form, the current and former spouse’s information should be either listed or it should be left blank if the applicant has never had a spouse.
- Signature on the Colorado form must be hand-signed, it cannot be electronic
- A clear copy of the applicant’s driver’s license is required.
- Applicant will receive the Colorado results. Once received, please email or fax a copy of the Colorado results to our Nashville DHS office email: ccbackground.dhs@tn.gov or fax: 615-532-9956.
Please do NOT send this form to Colorado. Please send it to TN DHS, and TN DHS will send it to Colorado.
Instructions
Email, fax or mail checklist, disclosure form and typed Colorado form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Connecticut
Checklist: Connecticut Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Connecticut form: https://www.tn.gov/content/dam/tn/human-services/documents/Connecticut.pdf
Please do NOT send this form to Connecticut. Please send it to TN DHS, and TN DHS will send it to Connecticut.
Instructions
Email, fax, or mail checklist, disclosure form and Connecticut form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Delaware
Checklist: Delaware Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Delaware form: https://www.tn.gov/content/dam/tn/human-services/documents/DE_CPR_Form.pdf
Please do NOT send this form to Delaware. Please send it to TN DHS, and TN DHS will send it to Delaware.
Instructions
Email, fax or mail checklist, disclosure form and Delaware form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
Florida
Checklist: Florida Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Florida form: https://www.tn.gov/content/dam/tn/human-services/documents/FL-Employment-Request-Form.pdf
Please do NOT send this form to Florida. Please send it to TN DHS, and TN DHS will send it to Florida.
Please do NOT sign as the requestor. TN DHS signs as the requestor.
Instructions
Email, fax or mail checklist, disclosure form and Florida form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Georgia
Checklist: Georgia Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Georgia Form: https://www.tn.gov/content/dam/tn/human-services/documents/Georgia.pdf
- Please note: the signature must be handwritten.
- Please note: the GA form mentions a “Request on Agency Letterhead” – TN DHS will create and submit the Request on Agency Letterhead.
Instructions
Email, fax, or mail checklist, disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Guam
Checklist: Guam Checklist
Forms: For CAN and Criminal
- Complete applicant information on Guam form: https://www.tn.gov/content/dam/tn/human-services/documents/Guam.pdf
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
Please do NOT send this form to Guam. Please send it to TN DHS, and TN DHS will send it to Guam.
Instructions
Email, fax or mail checklist, Guam form and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Hawaii
Checklist: Hawaii Checklist
Forms: For CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Hawaii form: https://www.tn.gov/content/dam/tn/human-services/documents/HI_Consent_Form.pdf
Please note: Hawaii requires the original form
Please do NOT send this form to Hawaii. Please send it to TN DHS, and TN DHS will send it to Hawaii.
Instructions
Mail a copy of the checklist, disclosure form and original Hawaii form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
Idaho
Checklist: Idaho Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Idaho form: https://www.tn.gov/content/dam/tn/human-services/documents/Idaho-release-form.pdf
Please note the following when completing the Idaho form:
- Have Idaho form notarized
Please do NOT send this form to Idaho. Please send the original form to TN DHS, and TN DHS will send it to Idaho.
Instructions
Email, fax or mail checklist, disclosure form and Idaho form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Illinois
Checklist: Illinois Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Illinois form: https://www.tn.gov/content/dam/tn/human-services/documents/IL_Form_CFS_689.pdf. Please Note: The Illinois form CFS 689 requires an actual applicant signature. Illinois rejects forms with electronic signatures.
- Complete Illinois criminal release form: Illinois Statewide Criminal Release | Instructions for Illinois Statewide Criminal Release
Please do NOT send the IL form to Illinois and please do NOT send the IL Criminal Release form to CastleBranch. Please send these forms to TN DHS, and TN DHS will send them to Illinois and to CastleBranch.
Instructions
Email, fax or mail checklist, disclosure form and Illinois forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Indiana
Checklist: Indiana Checklist
Forms: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
Instructions
Email, fax or mail checklist and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Please Note: Applicant completes online Indiana form, sent to applicant’s email, after disclosure form has been received in our office
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Iowa
Checklist: Iowa Checklist
Forms: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Iowa form: https://www.tn.gov/content/dam/tn/human-services/documents/IA_Form_470-3301.pdf
Please do NOT sign on Requestor’s signature line. TN DHS signs on that line.
Please do NOT send this form to Iowa. Please send the form to TN DHS, and TN DHS will send it to Iowa.
Instructions
Email, fax or mail checklist, disclosure form and Iowa form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Kansas
Checklist: Kansas Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete both Kansas forms: https://www.tn.gov/content/dam/tn/human-services/documents/Kansas%20Adult.pdf and https://www.tn.gov/content/dam/tn/human-services/documents/Kansas-Child-Form-1011.pdf
Please do NOT send these forms to Kansas. Please send the forms to TN DHS, and TN DHS will send them to Kansas.
Instructions
Email, fax or mail the checklist, disclosure form and both Kansas forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Kentucky
Checklist: Kentucky Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Kentucky form: https://www.tn.gov/content/dam/tn/human-services/documents/KYDCC-374-rev.pdf
Please note the following when completing the Kentucky form:
- Please make sure to include full name; ex. first name, middle name, nick name, maiden name, last name
- Kentucky requires a witness signature
- Applicant and witness signature dates must match
- A clear copy of the applicant’s driver’s license is required
Please do NOT send this form or payment to Kentucky. Please send the form to TN DHS, and TN DHS will send it to Kentucky with payment.
Instructions
Email, fax, or mail the checklist, disclosure form, clear copy of driver’s license and Kentucky form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Louisiana
Checklist: Louisiana Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Louisiana form: https://www.tn.gov/content/dam/tn/human-services/documents/LA%20CPS-CANS-Form-B.pdf
Please note the following when completing the Louisiana form:
- A clear copy of the applicant's driver's license is required
Please do NOT sign on the Requestor’s signature line. TN DHS will sign on that line.
Please do NOT send this form to Louisiana. Please send the form to TN DHS, and TN DHS will send it to Louisiana.
Instructions
Email, fax or mail checklist, disclosure form, clear copy of driver's license and Louisiana form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Maine
Checklist: Maine Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Maine form: https://www.tn.gov/content/dam/tn/human-services/documents/Maine-Release-Form.pdf
Please do NOT send this form to Maine. Please send the form to TN DHS, and TN DHS will send it to Maine.
Instructions
Mail a copy of the checklist, disclosure form and original Maine form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Maryland
Checklist: Maryland Checklist
Forms: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Maryland form: https://www.tn.gov/content/dam/tn/human-services/documents/Maryland%20CPS%20Background%20Form%201279A.pdf
Please note the following when completing the Maryland form:
- Maryland requires that the form be typed
- Maryland requires the form to be notarized
- Maryland requires the original form
Please do NOT send this form to Maryland. Please send the original form to TN DHS, and TN DHS will send it to Maryland.
Instructions
Mail a copy of the checklist, disclosure form and original Maryland form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Massachusetts
Checklist: Massachusetts Checklist
Form: for CAN and Criminal
- Complete Massachusetts form: https://www.tn.gov/content/dam/tn/human-services/documents/Massachusetts%20Form%20-%20received%2003-2023.pdf
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
Please do NOT send this form to Massachusetts. Please send the form to TN DHS, and TN DHS will send it to Massachusetts.
Instructions
Email, fax or mail checklist, Massachusetts form and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Michigan
Checklist: Michigan Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Michigan form: https://www.tn.gov/content/dam/tn/human-services/documents/Michigan.pdf
- Please do NOT send this form to Michigan. Please send it to TN DHS, and TN DHS will send it to Michigan.
- Please also note that the signature on the Michigan must be handwritten – it cannot be electronic.
Please note: Michigan requires a clear copy of the applicant’s driver’s license
Please do NOT send this form to Michigan. Please send the form to TN DHS, and TN DHS will send it to Michigan.
Instructions
Email, fax, or mail the checklist, disclosure form, clear copy of driver’s license and Michigan form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Minnesota
Checklist: Minnesota Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Minnesota form: https://www.tn.gov/content/dam/tn/human-services/documents/Minnesota-DHS-Consent-Form.pdf
Please Note: Have Minnesota form notarized
Please do NOT send this form to Minnesota with payment. Please send the form to TN DHS, and TN DHS will send it to Minnesota with payment.
Instructions
Email, fax or mail checklist, disclosure form and Minnesota form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Mississippi
Checklist: Mississippi Checklist
Form: for CAN and Criminal
- Applicant completes disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- In addition to electronic Identogo fingerprints, the applicant must also get their fingerprints completed in ink, on a hardcopy fingerprint card through their local Police Station, Sheriff’s Office, or vendor of their choice.
- Make a copy of the applicant’s hardcopy ink fingerprint card
- Once these steps are completed: mail original hardcopy fingerprint card (cannot be bent) to:
Mississippi Department of Health
Criminal History Record Check Unit
Attn: Julie Henderson
143B LeFleurs Square
Jackson, MS. 39211
- Also, please email or fax a copy of the applicant’s ink fingerprint card, a clear copy of the applicant’s driver’s license, Mississippi checklist and completed disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
- When the disclosure form, driver’s license, and copy of the ink fingerprint card are received in the Nashville DHS office, an online Mississippi DocuSign form will be emailed to the applicant’s email address listed on their disclosure form. Please have the applicant watch for this Mississippi DocuSign form in their inbox and junk/spam folders.
- Applicant completes and submits the online Mississippi Child Abuse Registry Check DocuSign Form.
*Mailing the hardcopy ink fingerprint card (cannot be bent) via USPS Priority Mail, FedEx, or UPS with a tracking number is recommended.
*TN DHS does not cover the payment for the hardcopy ink fingerprint to be completed or the mail delivery services*
*Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. Please also send all forms for each applicant together, including the checklist.
*Mailing these documents via USPS Priority Mail, FedEx, or UPS with a tracking number is recommended.
______________________________________________________________________________________________________________
Missouri
Checklist: Missouri Checklist
Form: for CAN and Criminal
- Applicant Completes disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Provider completes Employer Background Screening Request form: https://www.tn.gov/content/dam/tn/human-services/documents/Employer%20Background%20Screening%20Request%20Form.pdf
- For section “Employer associated with this registration”: please list this information as Provider’s (you) Child Care Agency information.
- Provider must call Missouri to verify if the applicant is registered in their system. If the applicant is not registered, the provider must register them. If the applicant is already registered, the provider must request the background check over the phone. Toll Free Number: (866) 422-6872; OR General Office Telephone: (573) 526-1974.
- To register online with a credit/debit card, go to: www.health.mo.gov/safety/fcsr
- To register via mail with a hard copy check/money order, etc., applicant must complete the Worker Registration Form: https://www.tn.gov/content/dam/tn/human-services/documents/Missouri.pdf and mail the form, applicant’s Social Security Card, and payment to:
- Missouri Department of Health and Senior Services
Attn: Fee Receipts
PO BOX 570
Jefferson, MO 65102
- Missouri Department of Health and Senior Services
- Please note that there is a one-time $14 registration fee that must be paid by the provider each time an applicant needs to be registered in the system (per Missouri’s law pertaining to this background check request, TN DHS is not authorized to cover this fee).
- Please Email, fax or mail a copy of the checklist, disclosure form and Missouri Screening results to our Nashville DHS office (if results have not been received by the time the Out of State documents are submitted to Nashville DHS, please provide proof of the applicant’s screening having been requested from Missouri):
Instructions
Email, fax or mail checklist, disclosure form and Missouri form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist
______________________________________________________________________________________________________________
Montana
Checklist: Montana Checklist
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Montana form: https://www.tn.gov/content/dam/tn/human-services/documents/MT_Form_CFS_400.pdf
Please note the following when completing the Montana form:
- Have Montana form notarized
Please do NOT send this form to Montana. Please send the form to TN DHS, and TN DHS will send it to Montana.
Instructions
Email, fax or mail checklist, disclosure form and Montana form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
Nebraska
Checklist: Nebraska Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Online Nebraska form will be sent to applicant’s email once disclosure form is received by TN DHs.
Instructions
Email, fax or mail checklist and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Please Note: Applicant completes online Nebraska form, sent to applicant’s email, after disclosure form has been received in our office
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Nevada
Checklist: Nevada Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Nevada form: https://www.tn.gov/content/dam/tn/human-services/documents/NV_Registry_Form.pdf
Please do NOT send this form to Nevada. Please send it to TN DHS, and TN DHS will send it to Nevada.
Please note: Nevada requires their form to be notarized
Instructions
Email, fax, or mail the checklist, disclosure form and notarized Nevada form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
New Hampshire
Checklist: New Hampshire Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete New Hampshire form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20Hampshire.pdf
- Complete New Hampshire criminal release form: https://www.tn.gov/content/dam/tn/human-services/documents/NH_SW_Criminal_Release.pdf
- Please Note: Have both New Hampshire forms notarized
Please do NOT send these forms to New Hampshire or to CastleBranch. Please send them to TN DHS, and TN DHS will send to New Hampshire and CastleBranch.
Instructions
Email, fax or mail checklist, disclosure form and notarized New Hampshire forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
New Jersey
Checklist: New Jersey Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the online New Jersey form:
Here is a link: https://www.njportal.com/dcf/cari
- Click on “File an Out of State CARI” in the lower left box.
- Then enter the following information for “Requesting Agency Name and Information”:
- Requesting Agency Name: TN Department of Human Services
- Staff Name: Basem Girgis
- Agency Email: CCBackground.DHS@tn.gov
- Contact Phone Number: 615-253-4170
- Address 1: James K. Polk Building, 15th Floor
- Address 2: 505 Deaderick Street
- City: Nashville
- State: Tennessee
- Zip: 37243
Please do NOT enter the center’s information as the requestor’s information. Please enter the information listed above for TN DHS.
Instructions
Email, fax or mail checklist and disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
New Mexico
Checklist: New Mexico Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete New Mexico form: https://www.tn.gov/content/dam/tn/human-services/documents/NM_CAN_Form.pdf
Please do NOT send this form to New Mexico. Please send it TN DHS, and TN DHS will send it to New Mexico.
Instructions
Email, fax or mail checklist, disclosure form and New Mexico form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
New York
Checklist: New York Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the New York form: https://www.tn.gov/content/dam/tn/human-services/documents/NY_Authorization_Form.pdf
Please note the following when completing the New York form:
- New York requires the form to be notarized
- New York requires the original form
Please do NOT send the original form to New York. Please send it to TN DHS, and TN DHS will send it to New York.
Instructions
Mail a copy of the checklist, disclosure form and original New York form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
North Carolina
Checklist: North Carolina Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete North Carolina Online Request form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20NC%20Instructions.pdf
- Please note: only the applicant is authorized to create a login and request this check.
- Please note: when requesting the background check, under “provider search,” the applicant must use code “InterstateApp” to let the system know they are requesting an Out of State check.
- Please note: the applicant must provide their previous NC address history.
- Please note: this form does NOT require a fee. If the applicant is prompted to pay a fee, please stop and contact NC. Let them know the applicant is requesting an “interstate” check for TN employment, and they will assist.
- Please note: the applicant will receive their results from NC – these must be forwarded to TN DHS as soon as they are received by the applicant.
Instructions
Email, fax or mail checklist, disclosure form and request confirmation of online North Carolina form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: Basem Girgis / OIG Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. Please also send all forms for each applicant together, including the checklist.
______________________________________________________________________________________________________________
North Dakota
Checklist: North Dakota Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete North Dakota form: https://www.tn.gov/content/dam/tn/human-services/documents/North%20Dakota.pdf
Please do NOT send this form to North Dakota. Please send it to TN DHS, and TN DHS will send it to North Dakota.
Instructions
Email, fax or mail checklist, disclosure form and North Dakota form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Northern Mariana Islands
Checklist: Northern Mariana Islands Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
Instructions
Email, fax, or mail checklist, disclosure form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Ohio
Checklist: Ohio Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Ohio form: https://www.tn.gov/content/dam/tn/human-services/documents/ohio-jfs-01175.pdf
Please do NOT send this form to Ohio. Please send it to TN DHS, and TN DHS will send it to Ohio.
Instructions
Email, fax or mail checklist, disclosure form and Ohio form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Oklahoma
Checklist: Oklahoma Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Oklahoma form: https://www.tn.gov/content/dam/tn/human-services/documents/Oklahoma-CANForm.pdf
· Applicant’s previous Oklahoma address needs to be listed on the Oklahoma form.
Please do NOT send this form Oklahoma. Please send it to TN DHS, and TN DHS will send it to Oklahoma.
Instructions
Email, fax or mail checklist, disclosure form and Oklahoma form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Oregon
Checklist: Oregon Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Oregon form: https://www.tn.gov/content/dam/tn/human-services/documents/Oregon-MSC-2702.pdf
Please note the following when completing the Oregon form:
- Oregon requires that the form be typed
Please do NOT send this form to Oregon. Please send it to TN DHS, and TN DHS will send it to Oregon.
Instructions
Email, fax or mail a copy of the checklist, disclosure form and Oregon form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Pennsylvania
Checklist: Pennsylvania Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete Pennsylvania forms: https://www.tn.gov/content/dam/tn/human-services/documents/PA-Consent-Release_Form.pdf and https://www.tn.gov/content/dam/tn/human-services/documents/PA-CY113-Form.pdf
Please do NOT send these forms to Pennsylvania. Please send them to TN DHS, and TN DHS will send them to Pennsylvania.
Instructions
Email, fax or mail checklist, disclosure form and Pennsylvania forms to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Puerto Rico
Checklist: Puerto Rico Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Puerto Rico forms: https://www.tn.gov/content/dam/tn/human-services/documents/Puerto%20Rico%20CAN%20Registry.pdf and https://www.tn.gov/content/dam/tn/human-services/documents/PR-Criminal-Release-Form.pdf
Please note the following when completing the Puerto Rico form:
· Puerto Rico requires the form to be witnessed (applicant and witness signatures dates must match)
Please do NOT send this form to Puerto Rico. Please send it to TN DHS, and TN DHS will send it to Puerto Rico.
Instructions
Email, fax or mail a copy of the checklist, disclosure form and Puerto Rico form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
Rhode Island
Checklist: Rhode Island Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Rhode Island form: https://www.tn.gov/content/dam/tn/human-services/documents/Rhode-Island-Registry-Check.pdf
- Please do NOT send this form to Rhode Island. Please send it to TN DHS, and TN DHS will send it to Rhode Island.
Email, fax or mail checklist, disclosure form, and Rhode Island form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: Basem Girgis / OIG Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
*Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. Please also send all forms for each applicant together, including the checklist.
______________________________________________________________________________________________________________
South Carolina
Checklist: South Carolina Checklist
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the South Carolina form:
- The online SC form will be sent to the applicant’s email once the TN Disclosure Form is received by our office.
- Please note: this form does NOT require a fee.
Please do NOT send this form to South Carolina. Please send it to TN DHS, and TN DHS will send it to South Carolina.
Instructions
Email, fax or mail a copy of the checklist, disclosure form and South Carolina form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
South Dakota
Checklist: South Dakota Checklist
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the South Dakota form: https://www.tn.gov/content/dam/tn/human-services/documents/SD_Self_Screening_Form.pdf
Please do NOT send this form to South Dakota. Please send it to TN DHS, and TN DHS will send it to South Dakota.
Please note the following when completing the South Dakota form:
- South Dakota requires the form to be notarized
Instructions
Email, fax or mail a copy of the checklist, disclosure form and South Dakota form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Texas
Checklist: Texas Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Texas form: https://www.tn.gov/content/dam/tn/human-services/documents/Texas.pdf
Please do NOT send this form to Texas. Please send it to TN DHS, and TN DHS will send it to Texas.
Please note the following when completing the Texas form:
- Texas requires the form to be notarized
Instructions
Email, fax or mail a copy of the checklist, disclosure form and Texas form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
Utah
Checklist: Utah Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Utah form: https://www.tn.gov/content/dam/tn/human-services/documents/Utah-Release-Form.pdf
Please do NOT send this form and driver’s license to Utah. Please send it to TN DHS, and TN DHS will send it to Utah.
Please Note: Utah requires a clear copy of the applicant’s driver’s license
Instructions
Email, fax, or mail the checklist, disclosure form, clear copy of driver’s license and Utah form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Vermont
Checklist: Vermont Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Vermont form: https://www.tn.gov/content/dam/tn/human-services/documents/VT-self-check-form.pdf
Please note the following when completing the Vermont form:
- Vermont requires the form to be notarized
- Vermont requires the original form
Please do NOT send this form to Vermont. Please send the original form to TN DHS, and TN DHS will send it to Vermont.
Instructions
Mail a copy of the checklist, disclosure form and original Vermont form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Virgin Islands
Checklist: Virgin Islands Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Virgin Islands form: https://www.tn.gov/content/dam/tn/human-services/documents/U.S.Virgin-Island-Form.pdf
Please note the following when completing the Virgin Islands form:
- The Virgin Islands require the form to be witnessed
Please do NOT send this form to the Virgin Islands. Please send it to TN DHS, and TN DHS will send it to the Virgin Islands.
Instructions
Email, fax or mail a copy of the checklist, disclosure form and Virgin Islands form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Virginia
Checklist: Virginia Checklist
Form: for CAN and Criminal
Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
Complete the Virginia form: https://www.tn.gov/content/dam/tn/human-services/documents/Virginia_1.pdf
Please note the following when completing the Virginia form:
- Virginia requires the form to be notarized
- Virginia requires the original form
Please do NOT send this form to Virginia. Please send the original form to TN DHS, and TN DHS will send it to Virginia.
Instructions
Mail a copy of the checklist, disclosure form and original Virginia form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Washington
Checklist: Washington Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Washington form: Washington State Child Abuse and Neglect Founded Findings Request from Another State
- Complete signature form: Washington Signature Authorization Form
Please Note: Washington requires that the form be typed and have a handwritten signature – cannot be electronic signature.
Please do NOT send this form to Washington. Please send it to TN DHS, and TN DHS will send it to Washington.
Instructions
Email, fax or mail a copy of the checklist, disclosure form and Washington form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Washington D.C.
Checklist: Washington D.C. Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Washington D.C. form: https://www.tn.gov/content/dam/tn/human-services/documents/Washington%20DC%20New.pdf
Please note the following when completing the Washington D.C. form:
- Washington DC requires a copy of the applicant’s driver’s license
Please do NOT send this form to Washington D.C. Please send the form to TN DHS, and TN DHS will send it to Washington D.C.
Instructions
Mail a copy of the checklist, disclosure form and original Washington D.C. form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
West Virginia
Checklist: West Virginia Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the West Virginia form: https://www.tn.gov/content/dam/tn/human-services/documents/West%20Virginia.pdf
Please Note: West Virginia requires the original form
Please do NOT send this form to West Virginia. Please send the original form to TN DHS, and TN DHS will send it to West Virginia.
Instruction
Mail a copy of the checklist, disclosure form and original West Virginia form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Wisconsin
Checklist: Wisconsin Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
- Complete the Wisconsin form: https://www.tn.gov/content/dam/tn/human-services/documents/WI_Form_5065.pdf
Please note the following when completing the Wisconsin form:
- Wisconsin requires the form to be witnessed
Please do NOT send this form to Wisconsin. Please send it to TN DHS, and TN DHS will send it to Wisconsin.
Instructions
Email, fax or mail a copy of the checklist, disclosure form and Wisconsin form to:
Email: ccbackground.dhs@tn.gov
Fax: 615-532-9956
Mail:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.
______________________________________________________________________________________________________________
Wyoming
Checklist: Wyoming Checklist
Form: for CAN and Criminal
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/New%20TN%20Disclosure%20Form%20(rev.%2010-2022).pdf
Please do NOT send this form to Wyoming. Please send the original form to TN DHS, and TN DHS will send it to Wyoming.
Instructions
Mail a copy of the checklist, disclosure form and original Wyoming form to:
Tennessee Department of Human Services
ATTN: OIG - Background Unit
James K. Polk Building, 15th Floor
505 Deaderick Street
Nashville, TN 37243
Disclaimer: Please do not send forms for applicants until at least one day after their fingerprints have been completed. And, please send all forms, for each applicant, together, including the checklist.