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Child Care Out of State Registry Check

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. 

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.

Select a State from the Tabs Below

Alabama

Checklist: Alabama Checklist

Form: for CAN and Criminal

Please note the following when completing the Alabama form:

  • Alabama requires the original form
  • 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

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

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

Checklist: American Samoa Checklist

Forms: For CAN and Criminal

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

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

Please note the following when completing the Arkansas form:

  • Have both Arkansas forms notarized

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

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

Please note the following when completing the Colorado form:

  • Colorado requires that the form be typed
  • At the top of page 3, on the Colorado form, the spouse’s information should be entered, or left blank, if the applicant does not have a spouse

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

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

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 

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

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

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

Please note: Hawaii requires the original form

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

Please note the following when completing the Idaho form:

  • Have Idaho form notarized

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

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

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

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

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

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

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

Please note the following when completing the Louisiana form:

  • A clear copy of the applicant's driver's license is required
  •  Our office will sign as the requestor in Section IV

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

Please note the following when completing the Maine form:

  • Maine requires the original form

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

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

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

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

Please note: Michigan 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 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

Please Note: Have Minnesota form notarized

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

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 Mississippi 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.

______________________________________________________________________________________________________________

Missouri

Checklist: Missouri Checklist

Form: for CAN and Criminal

Please note the following when completing the Missouri form:

  • Have Missouri form notarized

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

Please note the following when completing the Montana form:

  • Have Montana form notarized

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

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

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 Criminial

Please Note: Have both New Hampshire forms notarized

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

Here is a link: https://www.njportal.com/dcf/cari , please click on “File an Out of State CARI” in the lower left box and then, please 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

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

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

Please note the following when completing the New York form:

  • New York requires the form to be notarized
  • New York requires the original form

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

Instructions

Email, fax or mail checklist, disclosure form and North 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.

______________________________________________________________________________________________________________

North Dakota

Checklist: North Dakota Checklist

Form: for CAN and Criminal

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 Criminial

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

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

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

Please note the following when completing the Oregon form:

  • Oregon requires that the form be typed

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

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

Please note the following when completing the Puerto Rico form:

  • Puerto Rico requires the form to be witnessed

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

Instructions

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: 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 Carolina

Checklist: South Carolina Checklist

Please note the following when completing the South Carolina form:

  • South Carolina requires the form to be witnessed or notarized

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

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

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 

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 

Please note the following when completing the Vermont form:

  • Vermont requires the form to be notarized
  • Vermont requires the original form

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 

Please note the following when completing the Virgin Islands form:

  • The Virgin Islands require the form to be witnessed

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/hs-2779.docx

Complete the Virginia form: https://www.tn.gov/content/dam/tn/human-services/documents/VA_Form_032-02-0151-12_updated.pdf

Please note the following when completing the Virginia form:

  • Virginia requires the form to be notarized
  • Virginia requires the original form

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 

Please Note: Washington requires that the form be typed

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 

Please note the following when completing the Washington D.C. form:

  • Washington D.C. requires the form to be notarized
  • Washington D.C. requires the form be signed in blue ink
  • Washington D.C. requires the original form

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

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

Please Note: West Virginia requires the original form

Instructions

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 

Please note the following when completing the Wisconsin form:

  • Wisconsin requires the form to be witnessed

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 

Please Note: Wyoming requires the original form

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.

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