Form Msc 301 Qed - Background Check Request Form Page 7

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For subject individuals associated with private licensed childcaring agencies,
child foster homes or child adoptive homes. Child protective services history held by
the Department, regardless of the date of assessment or outcome, for which you were
found to be responsible, and include founded or substantiated child protective services
reports from states where you lived in the past 5 years.
If potentially disqualifying abuse is found, you will be contacted and asked to
provide additional information. Due to its sensitive nature, the information you
provide will not be disclosed to your potential employer or QED.
Authority — BCU is authorized by state law, to complete background checks on SIs
who work, volunteer or live with individuals who are vulnerable to abuse or
mistreatment (ORS 181.534, 181.537, 409.027 and 443.004; OAR 407-007-0200 to
407-007-0370, OAR 943-007-000 to 943-007-0501). Vulnerable individuals include
children, senior citizens and individuals with physical disabilities, developmental
disabilities or mental illness. A check may be required even if you, the SI, do not
have direct contact with vulnerable individuals.
Sources checked — BCU may check information from the Driver and Motor Vehicle
Services Division, Department of Corrections, Oregon State Police, Federal Bureau
of Investigation and local, state and federal courts. BCU may use information from
other criminal justice, corrections and law-enforcement agencies and other state and
local government agencies. You may be requested to provide fingerprints for a
national criminal records check.
Challenging criminal information — If you want to obtain a copy of your record, or
challenge information in the record, you must contact the Oregon State Police, 503-
378-3070, extension 330 (for Oregon criminal records) or the Federal Bureau of
Investigation, 304-625-3878 (for national criminal records). You may request a copy
of the national FBI report from BCU. Depending on your previous contacts with law
enforcement and courts, you may need to contact several sources to find your
complete criminal records.
Rechecks — This background check process may be repeated at any time while
you work, reside or otherwise continue in this position.
If you have questions or need this form in large print or in a different format, contact the qualified
entity listed in section 1, box 1.
Keep these instructions for your records.
Page 7 of 7
MSC 301 QED (10/12)

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