Child Day Care - Staff Application Fee Form

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FAMILY CHILD CARE HOME LICENSE
STAFF INITIAL APPLICATION CHECKLIST
Dear Family Child Care Staff Applicant: Thank you for your interest in wanting to become Family Child Care
Home Staff. Please follow the instructions below to apply for the approval.
Submit an Application Packet Complete each form listed below in blue or black ink and answer all
the questions completely. We will begin processing your application as soon as we receive the Application Fee
and the Application Form. You may send the rest of the forms as soon as they are completed. Background check
responses can take more than 60 days. In order for the OEC to have the legal authority to process the background
check paperwork, you must submit the licensing application form before or with the background check materials.
ALONG WITH THIS APPLICATION, YOU MUST INCLUDE:
$15.00 Application Fee and Fee Invoice Form - Make your check payable to “Treasurer
o
State of Connecticut”. This fee is not refundable.
“Adult Medical Statement for Child Care”- Physical examination and TB test must have
o
been within the past year. Adult Medical Statement forms can be found at:
First Aid Certification – A copy of a certificate, front and back, documenting the
o
successful completion of an approved course in first aid approved for child care providers.
(For substitutes only) A list of approved First Aid Courses can be found at:
References – Submit three Request for Reference Forms to be completed and signed by
o
individuals (no more than one relative) that have known you for at least three years.
o
Fingerprints - Submit one fingerprint card (green).
Fingerprint Fee - Enclose a $14.75 check payable to “Treasurer, State of Connecticut” for
o
each person’s fingerprints. This fee is not refundable.
DCF “Authorization for Release of Information”
o
If you have obtained this application on-line, please call the Connecticut Office of Early Childhood
@ 860-509-8303 to obtain a fingerprint packet.
Send F
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to:
ALL OTHER APPLICATION MATERIALS
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Connecticut Office of Early Childhood
Connecticut Office of Early Childhood
Legal Division
Licensing Division
410 Capitol Avenue #12 CBR
410 Capitol Avenue MS #12 CBR
P.O. Box 340308
P.O. Box 340308
Hartford, CT 06134-0308
Hartford, CT 06134-0308

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