Authorization For Background Study - Steele County Human Services Page 2
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1
2BACKGROUND CHECK INFORMATION SHEET
The applicant/license holder listed on the Authorization for Background Study is required to be licensed by the
Department of Human Services pursuant to MN, Statute 245A.04, subd. 3.
The applicant/license holder, state and local agencies are required to assist with the study by giving the commissioner of
Human Services background information regarding the individual named on the Authorization for Background Study. The
study must include information from the County agency’s records of substantiated abuse or neglect of adults and the
maltreatment of minors, records from local sheriff and/or police, and information from the Bureau of Criminal
Apprehension and/or Juvenile Court.
NATURE OF INFORMATION TO BE DISCLOSED:
Minnesota Statutes, Section 245.04, Subd. 3 authorizes disclosure of all criminal convictions, arrest information, reports
regarding abuse or neglect and investigation results available from local, state and national criminal history record
repositories on all individuals connected with the application for or renewal of a license including: applicants, operators,
persons living in the household (over the age of thirteen (13), employees, contractors and unsupervised volunteers who
have direct contact with persons served by the program. The disclosure of information is authorized after notice is given
to the subject of the data.
DISCLOSURES:
The information will be disclosed to the Minnesota Department of Human Services, the director of any local agency
responsible for licensing or their representatives. The license applicant or license holder will be informed if the
information provided would jeopardize the status of their license if the person on whom information disclosed maintains
an affiliation with the licensed program.
RECONSIDERATION:
Except as otherwise provided by DHS rules, an applicant/licensed holder or family member, prospective or current
employee/contractor, volunteers may request reconsideration of the Department determination the results of a background
study require the person’s disqualification. The request must be submitted in writing and accompanied by proof that the
information the Department relied upon was erroneous or that the person’s employment/contract/volunteering does not
pose a risk of harm to persons serviced by the program. A request for reconsideration must be mailed within thirty (30)
days of the date the notice to the applicant/license holder is sent.
INFORMATION REQUESTED BY:
Steele County Human Services
630 Florence Avenue, P.O. Box 890
Owatonna, MN 55060
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