Cfs 718-4 - Request For Transfer Of Background Clearance Information
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1CFS 718-4
State of Illinois
Rev 1/2013
Department of Children & Family Services
Central Office of Licensing
REQUEST FOR TRANSFER OF
BACKGROUND CLEARANCE INFORMATION
In accordance with Rule 385, Background Checks, facilities licensed by the Department of Children &
Family Services may request transfer of background check clearances for their employees. In order to
be eligible for transfer of information, the person must be transferring employment from one licensed
child care facility to another.
This request must be completed by the facility operator and include a newly completed CFS-718E
Authorization Form attached to this request.
COMPLETE THE FOLLOWING INFORMATION:
Employee Name
SS#
Name of Facility Where Previously Employed
Provider ID# (if known)
Address of Facility/City/State/Zip
Date Employment Ended
Name of Facility Where Currently Employed
Provider ID#
Date of Employment
Attach CFS 718E and FAX TO: (312) 328-2131
OR
MAIL TO:
Central Office of Licensing/BCU
Department of Children and Family Services
th
1911 S. Indiana, 7
Floor
Chicago, Illinois 60616
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