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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- 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
- 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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete Alaska form: https://www.tn.gov/content/dam/tn/human-services/documents/AK_Form_06-9437.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
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/hs-2779.docx
- Complete Arizona form: https://www.tn.gov/content/dam/tn/human-services/documents/AZ_Form_DCS-1083A.pdf
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/hs-2779.docx
- 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
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/hs-2779.docx
- Complete California form: https://www.tn.gov/content/dam/tn/human-services/documents/California-BCIA-4056.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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete the Colorado form: https://www.tn.gov/content/dam/tn/human-services/documents/CO-BackgroundChecks_IndividualInquiryForm.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete Connecticut form: https://www.tn.gov/content/dam/tn/human-services/documents/CT_Form_DCF-3031.pdf
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/hs-2779.docx
- Complete Delaware form: https://www.tn.gov/content/dam/tn/human-services/documents/DE_CPR_Form.pdf
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/hs-2779.docx
- Complete Florida form: https://www.tn.gov/content/dam/tn/human-services/documents/FL-Employment-Request-Form.pdf
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/hs-2779.docx
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_Form.pdf
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
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/hs-2779.docx
- 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
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/hs-2779.docx
- 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
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/hs-2779.docx
- 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
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/hs-2779.docx
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/hs-2779.docx
- Complete Iowa form: https://www.tn.gov/content/dam/tn/human-services/documents/IA_Form_470-3301.pdf
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/hs-2779.docx
- Complete both Kansas forms: https://www.tn.gov/content/dam/tn/human-services/documents/Kansas-Adult-Form-10400.pdf and https://www.tn.gov/content/dam/tn/human-services/documents/Kansas-Child-Form-1011.pdf
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/hs-2779.docx
- 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
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/hs-2779.docx
- 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
- 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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete the Maine form: https://www.tn.gov/content/dam/tn/human-services/documents/Maine-Release-Form.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- 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
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 applicant information on Massachusetts form: https://www.tn.gov/content/dam/tn/human-services/documents/Massachusetts-CAN-Form.pdf
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
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/hs-2779.docx
- Complete the Michigan form: https://www.tn.gov/content/dam/tn/human-services/documents/MI_Form_DHS_1929_(1-2018).pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete Minnesota form: https://www.tn.gov/content/dam/tn/human-services/documents/Minnesota-DHS-Consent-Form.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete Missouri form (*Please do not check any boxes indicating which checks need to be completed at the top of the form, we will handle this portion.): https://www.tn.gov/content/dam/tn/human-services/documents/MO_Form_300-1590s.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- 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
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/hs-2779.docx
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/hs-2779.docx
- Complete the Nevada form: https://www.tn.gov/content/dam/tn/human-services/documents/NV_Registry_Form.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete New Hampshire form: https://www.tn.gov/content/dam/tn/human-services/documents/New_Hampshire_form.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
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/hs-2779.docx
- Complete the online New Jersey form:
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete New Mexico form: https://www.tn.gov/content/dam/tn/human-services/documents/NM_CAN_Form.pdf
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/hs-2779.docx
- 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
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/hs-2779.docx
- Complete North Carolina form: https://www.tn.gov/content/dam/tn/human-services/documents/NC_CBC_Form.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete North Dakota form: https://www.tn.gov/content/dam/tn/human-services/documents/North-Dakota-SFN433.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
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/hs-2779.docx
- Complete Ohio form: https://www.tn.gov/content/dam/tn/human-services/documents/ohio-jfs-01175.pdf
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/hs-2779.docx
- Complete Oklahoma form: https://www.tn.gov/content/dam/tn/human-services/documents/Oklahoma-CANForm.pdf
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/hs-2779.docx
- 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
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/hs-2779.docx
- 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
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/hs-2779.docx
- 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
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/hs-2779.docx
- Complete Rhode Island form: https://www.tn.gov/content/dam/tn/human-services/documents/Rhode-Island-Registry-Check.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete the South Carolina form: https://www.tn.gov/content/dam/tn/human-services/documents/SC_Form_DSS_3072.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete the South Dakota form: https://www.tn.gov/content/dam/tn/human-services/documents/SD_Self_Screening_Form.pdf
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/hs-2779.docx
- Complete the Texas form: https://www.tn.gov/content/dam/tn/human-services/documents/TX%20Form%20500-2970%2011-13-17.pdf
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/hs-2779.docx
- Complete the Utah form: https://www.tn.gov/content/dam/tn/human-services/documents/Utah-Release-Form.pdf
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/hs-2779.docx
- 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
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/hs-2779.docx
- 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
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete the Washington form: Washington State Child Abuse and Neglect Founded Findings Request from Another State
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete the Washington D.C. form: https://www.tn.gov/content/dam/tn/human-services/documents/DC%20CPR%20App%20New.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- Complete the West Virginia form: https://www.tn.gov/content/dam/tn/human-services/documents/WV_Authorization_Release.pdf
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
- Complete disclosure form: https://www.tn.gov/content/dam/tn/human-services/documents/hs-2779.docx
- 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
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/hs-2779.docx
- Complete the Wyoming form: https://www.tn.gov/content/dam/tn/human-services/documents/WY_SS-26_Form.pdf
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.