Background Authorization - Washington State Department Of Early Learning (Page 4 of 4) in pdf

11. You MUST answer YES or NO. If your answer is YES you MUST fill in your conviction information. This includes:



Crime - The name of the crime as listed on the conviction records



Decision – Example: Guilty, probation…



Jurisdiction – You must clearly identify what court system this crime was processed through.



Example: WA superior court.



Decision date: based on the conviction records what is the date of the conviction

12. You MUST answer YES or NO. If your answer is YES you MUST fill in your pending charges information. This

includes:



Crime - The name of the crime as listed on the charging records



Degree – Example: Felony, misdemeanor…



Jurisdiction – You must clearly identify what court system this crime was processed through.



Example: WA superior court.



Charge date: the date the court system charged you with the crime

13. through 18. You MUST answer YES or NO.

19. You MUST read the statement in this box. Your signature under number 20 means you have read and agree to the

statements in number 19.

20. You MUST sign your name here.

21. If you are NOT 18 years old, your parent or guardian MUST also sign here or provide proof of emancipation.

22. You MUST fill in the location where you signed this form. Example: Name of city or county

23. You MUST fill in the date you signed this form and submit the form to the local DEL office.

The fingerprint process for DEL is as follows, effective 2/1/2011

1. Submit this form to the local DEL office

2. Local DEL office will issue a fingerprint appointment form and send it to the licensee identified by you on this form

in section 2.

3. Contact L-1 (fingerprint vendor) to schedule an appointment

4. Licensee must pay for the fingerprint process by:



E-Check from Saving or Checking Account



Credit or Debit Card



L-1 Enrollment Services Preapproved escrow account

REMINDER

Department of Early Learning Chapter 43.215 RCW 43.215.215(2) In order to determine the suitability of

applicants for an agency license, licensees, their employees, and other persons who have unsupervised access

to children in care, and who have not resided in the state of Washington during the three-year period before being

authorized to care for children, shall be fingerprinted.

(a) The fingerprints shall be forwarded to the Washington state patrol and federal bureau of investigation for a

criminal history record check.

(b) The fingerprint criminal history record checks shall be at the expense of the licensee. The licensee may not pass this

cost on to the employee or prospective employee, unless the employee is determined to be unsuitable due to his or her

criminal history record.

DO NOT GO TO A POLICE DEPARTMENT TO HAVE FINGERPRINTS PROCESSED

10.9.2.1 Background Check Form

Rev. 8/11

Background Authorization - Washington State Department Of Early Learning Page 4

Related Articles

Related forms

Related Categories