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Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
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A person interested in being associated with operations regulated by Child Care Licensing (CCL) must use this form to submit a risk evaluation for himself or herself if that person:
- has criminal history or Central Registry (or out-of-state abuse/neglect) history that is a violation of minimum standards that is eligible for a risk evaluation; and
- is pursuing an association (including employment or volunteering) with a child care operation or home regulated by CCL.
To complete this form, fill in all fields with the appropriate information.
Send the completed form and the additional required documents (from the checklist on the form) to your CCL Centralized Background Check Unit (CBCU) representative via mail, email or fax by the due date provided in the Background Check Results Requiring Action letter. The name, mailing address, email address and fax number of the CBCU representative are listed at the bottom of the Background Check Results Requiring Action letter. Keep a copy of this form and the attachments for your files.
Once CBCU receives and processes all required documentation, CBCU will send you a letter notifying you whether or not the risk evaluation was approved. An approved or conditionally approved risk evaluation is specific to a particular role.
Note: If you have an approved or conditionally approved risk evaluation and your role at the operation changes, the risk evaluation is no longer valid. A new risk evaluation must be submitted and approved.
If CBCU denies the risk evaluation, you are not eligible to work at or with the operation, effective immediately upon receipt of the risk evaluation determination letter.