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Outline

The Alabama Central Registry Clearance form is an essential document for individuals and organizations involved in the care and supervision of children. This form is primarily used to request a background check through the Alabama Department of Human Resources to ensure that potential caregivers have not been implicated in child abuse or neglect. It requires the submission of personal details, including the name, date of birth, and address of the individual being cleared, along with information about their employment or volunteer role. The form also gathers data about the individual’s family members and previous residences in Alabama, which helps to create a comprehensive background check. Additionally, the form includes a section for the requesting person or agency to provide their contact information and specify their relationship to the individual being cleared. By signing the form, the individual authorizes the release of information from the Child Abuse/Neglect Central Registry, thereby waiving certain rights regarding the review of the information. The completed form is then submitted to the appropriate address, where the Department of Human Resources will conduct a search of the registry and provide the results, ensuring that the safety and well-being of children remain a top priority in Alabama.

Sample - Alabama Central Registry Clearance Form

ALABAMA DEPARTMENT OF HUMAN RESOURCES
CHILD ABUSE / NEGLECT (CA/N) CENTRAL REGISTRY CLEARANCE
PRINT OR TYPE in black or blue ink. Additional information regarding the CA/N Central Registry is on the back of this form.
** See instructions
for the address to use when submitting this form. **
Requesting Person or Agency/Organization
Check All That Apply
Mailing Address Child Placing Agency
Residential Child Care Facility
Child Day / Night Care Center
Telephone Number ( ) Email:
Family Day / Night Care Home
PRINT Requestor’s Name Exempt Child Day Care Center
Requestor
Signature
Date Medicaid Rehab. Provider
DHR Vendor
Witness
Signature
Date
Other (Please Specify)
_________________________________
The person whose name and identifying information, printed or typed below, will provide unsupervised care and
supervision of children
as an employee volunteer other. This person’s specific job/role is or will be:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Name _____________________________________________
Last First Middle
Sex
Male
Female
Race ___________ DOB ___/___/______
Current Mailing Address __________________________________________________________________________
Alias, Maiden & Prior Married Name(s) ______________________________________________________________
Name & DOB of Spouse & Former Spouse(s) _________________________________________________________
Name & DOB of Children / Stepchildren ______________________________________________________________
Alabama counties where person has lived and/or worked _________________________________________________
Attach additional pages as needed to provide all information requested above.
To be completed by person being cleared
I authorize the Alabama Department of Human Resources to release information contained in the Child Abuse / Neglect Central
Registry about me to the above named person/agency/organization. I hereby waive any right to any review or hearing to which I may
otherwise be entitled. I further release the Department of Human Resources, its officers, and employees from any and all claims
arising out of or in any way connected to the release or dissemination of any information concerning me.
_________________________________
Signature
________________
Date
_________________________________
Signature of Witness
________________
Date
To be completed by DHR
A search of the Alabama Child Abuse / Neglect Central Registry has been completed with the information provided to
determine if the person identified above has been named as being responsible for child abuse or neglect in Alabama.
DHR releases only
that information which is necessary to discover or prevent child abuse / neglect.
Substantiated report (i.e., indicated) located. See attached information.
Type Report:
Physical Abuse Neglect Sexual Abuse Mental Abuse / Neglect
No report located.
Request Denied ______________________________________________________________________________
Other _________________________________________________________________________________________
_________________________________________________________
Office of Child Protective Services
______________________________________
Date Completed
DHR-FCS-1598 (Revised December 2009)

Form Information

Fact Name Details
Governing Law The Alabama Central Registry Clearance form is governed by the Alabama Code, specifically Title 38, Chapter 12, which pertains to child protection and welfare.
Purpose This form is used to conduct background checks on individuals who will provide unsupervised care for children, ensuring their safety and well-being.
Submission Instructions Instructions for submitting the form, including the appropriate address, are provided on the back of the document.
Information Required The form requires personal details such as name, date of birth, address, and information about any aliases or prior names.
Authorization Individuals must authorize the Alabama Department of Human Resources to release information regarding their history of child abuse or neglect.
Witness Requirement A witness must sign the form to validate the authorization, ensuring that the process is transparent and accountable.
Outcome of the Request The form indicates whether a substantiated report of child abuse or neglect exists for the individual, affecting their eligibility for child care roles.

Detailed Guide for Filling Out Alabama Central Registry Clearance

Once you have gathered all necessary information, it's time to complete the Alabama Central Registry Clearance form. Ensure that you provide accurate details, as this will facilitate a smooth processing of your request.

  1. Obtain the Alabama Central Registry Clearance form.
  2. Use black or blue ink to fill out the form, either by printing or typing.
  3. In the "Requesting Person or Agency/Organization" section, check all applicable boxes, including options like "Child Placing Agency" or "Residential Child Care Facility."
  4. Provide your mailing address, telephone number, and email address.
  5. Print the requestor’s name and specify the requestor date.
  6. Sign the form as the requestor and include the date of signature.
  7. Identify the person who will provide unsupervised care and supervision of children. Fill in their name, sex, race, and date of birth.
  8. List the current mailing address of the person being cleared.
  9. Include any aliases, maiden names, or prior married names of the individual.
  10. Provide the names and dates of birth of the spouse and former spouse(s), as well as any children or stepchildren.
  11. List the Alabama counties where the individual has lived and/or worked.
  12. If more space is needed, attach additional pages with the required information.
  13. Have the person being cleared sign the authorization section, waiving their right to review or hearing.
  14. Include the signature and date of a witness for the authorization.

After you complete the form, make sure to send it to the appropriate address as indicated in the instructions. Await confirmation or any further communication from the Alabama Department of Human Resources regarding the status of your request.

Obtain Answers on Alabama Central Registry Clearance

  1. What is the purpose of the Alabama Central Registry Clearance form?

    The Alabama Central Registry Clearance form is used to check if an individual has been reported for child abuse or neglect in Alabama. This process is crucial for organizations that provide care for children, ensuring the safety and well-being of those in their care. By completing this form, agencies can verify that employees or volunteers do not have a history that would disqualify them from working with children.

  2. Who needs to fill out this form?

    This form should be completed by individuals or organizations that are seeking to provide unsupervised care and supervision of children. This includes, but is not limited to:

    • Child Placing Agencies
    • Residential Child Care Facilities
    • Child Day/Night Care Centers
    • Family Day/Night Care Homes
    • Medicaid Rehabilitation Providers

    Any person who will be involved in the care of children in these settings must have their information submitted for a background check.

  3. How do I submit the form?

    After filling out the form, it must be sent to the appropriate address as indicated in the instructions on the back of the form. It is important to ensure that the form is completed in black or blue ink, and all required information is provided. Missing information may delay the processing of your request.

  4. What information is required on the form?

    The form requires detailed information about the individual being cleared. This includes:

    • Full name (first, middle, last)
    • Date of birth
    • Current mailing address
    • Aliases, maiden names, and prior married names
    • Names and dates of birth of spouse(s) and children
    • Counties in Alabama where the person has lived or worked

    Completing all sections accurately is essential for a thorough background check.

  5. What happens after I submit the form?

    Once the form is submitted, the Alabama Department of Human Resources will conduct a search of the Child Abuse/Neglect Central Registry. They will determine if the individual has been named in any substantiated reports of child abuse or neglect. The findings will be communicated to the requesting agency or organization.

  6. What if a report is found?

    If a substantiated report is located, the requesting agency will receive the relevant information regarding the nature of the report. This may include details about physical abuse, neglect, sexual abuse, or mental abuse/neglect. The agency will then decide how to proceed based on this information. If no report is found, the request will be approved, allowing the individual to work with children.

Common mistakes

Filling out the Alabama Central Registry Clearance form is an important step for individuals seeking to work with children. However, mistakes during this process can lead to delays or even denials. Here are eight common errors to avoid.

One frequent mistake is failing to use black or blue ink. The instructions clearly state that the form should be completed in these colors. Using other colors can cause confusion or make the form difficult to read, potentially leading to processing issues.

Another common error is not checking all applicable boxes in the "Requesting Person or Agency/Organization" section. It is crucial to indicate all relevant roles, such as whether you are a child placing agency or a residential child care facility. Omitting this information can result in the form being returned for correction.

Many applicants also overlook the importance of providing complete and accurate personal information. This includes the full name, date of birth, and current mailing address of the person being cleared. Incomplete information can delay the processing time significantly.

Additionally, some individuals forget to include aliases or prior married names. The form specifically asks for this information, and failing to disclose it may lead to discrepancies during the background check, which could complicate the approval process.

Another mistake involves neglecting to list all relevant family members. This includes spouses, former spouses, and children. Providing this information is essential for a thorough background check, and missing details can hinder the review process.

Many applicants also fail to sign the form in the designated areas. Both the person being cleared and a witness must sign the document. A missing signature can lead to outright rejection of the application.

Some individuals do not pay attention to the submission address provided in the instructions. It’s important to send the form to the correct location to ensure it is processed without unnecessary delays. Double-checking this detail can save time and frustration.

Lastly, applicants sometimes forget to attach additional pages when necessary. If there is not enough space to provide all required information, additional pages should be included. Not doing so can result in an incomplete application, leading to further complications.

By avoiding these common mistakes, individuals can ensure a smoother experience when filling out the Alabama Central Registry Clearance form. Attention to detail is key in this important process.

Documents used along the form

When navigating the requirements for child care and protection in Alabama, several forms and documents are often utilized alongside the Alabama Central Registry Clearance form. These documents help ensure the safety and well-being of children in various care settings. Here is a list of important forms that may be needed:

  • Background Check Authorization Form: This form allows an individual to give permission for a background check to be conducted. It typically includes personal information such as name, address, and social security number.
  • Child Care Provider Application: Required for individuals seeking to operate a child care facility, this application collects information about the provider's qualifications, experience, and the facility's operational details.
  • Child Care Licensing Application: This document is submitted to obtain a license to operate a child care center. It includes details about the facility, staff, and compliance with health and safety regulations.
  • Incident Report Form: This form is used to document any incidents that occur at a child care facility, including accidents or injuries. It helps maintain transparency and accountability.
  • Health and Safety Checklist: A checklist that ensures child care providers meet health and safety standards. It covers areas such as sanitation, emergency procedures, and child supervision.
  • Child Enrollment Form: This form collects essential information about each child enrolled in a care program, including emergency contacts, medical history, and parental consent.
  • Staff Training Record: This document tracks the training and certifications of staff members working in child care. It helps ensure that all employees are qualified and knowledgeable about child care practices.
  • Parent Handbook: A guide provided to parents that outlines the policies, procedures, and expectations of the child care program. It serves as a resource for parents to understand their rights and responsibilities.
  • Child Behavior Report: Used to document and address behavioral issues in children, this report helps staff track progress and communicate with parents about their child's development.
  • Emergency Contact Form: This form lists individuals who can be contacted in case of an emergency involving a child. It is vital for ensuring the safety and well-being of children in care.

Understanding and preparing these documents can significantly streamline the process of obtaining necessary clearances and licenses. Each form plays a crucial role in maintaining compliance with state regulations and ensuring the safety of children in care settings. Be proactive in gathering these documents to avoid any delays in your child care operations.

Similar forms

The Alabama Central Registry Clearance form is crucial for ensuring the safety of children in various care settings. It shares similarities with several other important documents. Here’s a look at six of them:

  • Child Protective Services (CPS) Background Check: Like the Alabama Central Registry Clearance, this document assesses whether an individual has a history of child abuse or neglect. Both forms aim to protect children by ensuring that caregivers are vetted for any harmful past behavior.
  • Foster Care Licensing Application: This application requires a thorough background check, similar to the Alabama Central Registry Clearance. Both documents ensure that individuals seeking to care for children have no disqualifying histories.
  • Child Care Provider Application: When individuals apply to become licensed child care providers, they must undergo background checks. This process mirrors the Alabama Central Registry Clearance in its intent to safeguard children from potential harm.
  • Adoption Home Study: The home study process evaluates prospective adoptive parents, including background checks. Like the Alabama Central Registry Clearance, it aims to ensure that children are placed in safe and nurturing environments.
  • School Employee Background Check: Schools often conduct background checks on employees and volunteers who work with children. This is akin to the Alabama Central Registry Clearance, as both documents seek to prevent individuals with abusive histories from interacting with minors.
  • Volunteer Application for Youth Programs: Organizations that work with children frequently require volunteers to complete background checks. This requirement is similar to the Alabama Central Registry Clearance, as it helps ensure that those who supervise children do not pose a risk.

Dos and Don'ts

When filling out the Alabama Central Registry Clearance form, it is essential to follow specific guidelines to ensure the process goes smoothly. Here are six important dos and don'ts:

  • Do print or type your information clearly in black or blue ink.
  • Do check all applicable boxes for your requestor type, such as Child Placing Agency or Residential Child Care Facility.
  • Do provide complete names and dates of birth for all family members, including spouses and children.
  • Do attach additional pages if necessary to provide all requested information.
  • Don't leave any sections blank; ensure all fields are filled out as required.
  • Don't forget to sign and date the form, along with the witness signature if applicable.

By adhering to these guidelines, you can help ensure that your application is processed efficiently and without unnecessary delays.

Misconceptions

Misconceptions about the Alabama Central Registry Clearance form can lead to confusion and misinformation. Here are five common misconceptions:

  • The form is only for employees of child care facilities. Many believe that only employees need to complete this form. In reality, volunteers and individuals providing unsupervised care also need to submit it.
  • Submitting the form guarantees a clean record. Some think that completing the form ensures they will not have any issues. However, the form merely requests a background check; results depend on the findings in the registry.
  • The clearance is a one-time process. Many individuals assume that once they receive clearance, they are set for life. In fact, periodic checks may be required, especially if there are changes in employment or if the individual moves.
  • The form can be submitted without complete information. Some people believe they can send in the form even if it is not fully completed. Incomplete forms may lead to delays or denials, as all requested information is necessary for processing.
  • The form is only for those with a criminal record. There is a misconception that only individuals with prior offenses need to fill out this form. In truth, it is required for anyone who will have unsupervised access to children, regardless of their background.

Key takeaways

When filling out the Alabama Central Registry Clearance form, consider the following key points:

  • Accurate Information: Ensure that all information is printed or typed clearly in black or blue ink. This includes the names, addresses, and dates of birth of the individuals involved.
  • Submission Guidelines: Follow the instructions carefully for submitting the form. Pay attention to the address provided for the Department of Human Resources.
  • Authorization Requirement: The individual being cleared must sign the authorization section. This allows the Department of Human Resources to release necessary information regarding child abuse or neglect.
  • Understanding Results: Be aware that the results will indicate whether there is a substantiated report against the individual. If no report is located, the request will be denied.