Form Cclu 2 - Criminal History Record Information Authorization (Page 2 of 2) in pdf

Form Cclu 2 - Criminal History Record Information Authorization Page 2

CCLU 2

Fingerprints submitted within the last three years?

If you have had fingerprints completed for DHHS you may not need

to repeat fingerprinting. If you are unsure PLEASE call us at 603-271-9025! Refer to the Frequently Asked Questions from Child

Care Licensing located at:

ttp://

•

NH STATE BACKGROUND CHECK ONLY

New staff are required to have state background checks, even if they have already completed a FBI

•

(fingerprint) background check in the last 3 years

All staff at licensing renewal unless provided for under He-C 4002.05(b).

•

Please include:

1. A check for $7.50 payable to: State of NH – Criminal Records

2. The notarized form, CCLU-2, with original signatures

Mail to:

Department of Safety, Division of State Police

Criminal Records Unit

33 Hazen Drive

Concord, NH 03301

Submit a household and personnel form for the person being submitted for a state background check to:

Child Care Licensing Unit

129 Pleasant Street

Concord, NH 03301

Fingerprints: Complete form CCLU-1 (this is form CCLU-2), following the instructions on page 2 of that form.

ALL SECTIONS OF THE CRIMINAL HISTORY RECORD INFORMATION AUTHORIZATION CHILD DAY CARE

FORM MUST BE COMPLETED FULLY IN INK AND MUST BE LEGIBLE. Incomplete forms or payment may result

forms being returned and delay the results of background check completion. All signatures must be original. Photocopies of the

signed and notarized form will not be accepted. State Police will no longer accept previously issued release forms from the Child

Care Licensing Unit.

KEEP COPIES OF ALL DOCUMENTATION FOR YOUR RECORDS

Please visit for additional information.

If you need clarification or have any questions, we welcome your calls 603-271-9025.

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Form Cclu 2 - Criminal History Record Information Authorization Page 2