The Alabama Central Registry Clearance form is a document used to request a background check from the Alabama Department of Human Resources regarding child abuse and neglect. This form is essential for individuals or organizations that plan to provide unsupervised care for children, ensuring the safety and well-being of minors. Completing the form accurately is crucial for obtaining the necessary clearance to work in child-related environments.
The Alabama Central Registry Clearance form serves a crucial role in safeguarding children by ensuring that individuals seeking to provide unsupervised care or supervision have been thoroughly vetted for any history of child abuse or neglect. This form is not just a bureaucratic requirement; it is a vital tool for child placing agencies, residential child care facilities, and various day care centers. When filled out, it captures essential information about the individual in question, including their name, date of birth, and previous addresses, as well as details about their family and any aliases. The form also requires the applicant to authorize the Alabama Department of Human Resources to disclose any relevant findings from the Child Abuse/Neglect Central Registry. Importantly, it emphasizes the need for transparency and accountability, as the individual waives their right to a review of any findings that may arise. Once submitted, the Department conducts a thorough search to determine if there are any substantiated reports of abuse or neglect associated with the individual, thus playing a pivotal role in child protection efforts across the state. This process not only promotes the safety of children but also serves to reassure parents and guardians that those entrusted with their care have undergone rigorous scrutiny.
ALABAMA DEPARTMENT OF HUMAN RESOURCES
CHILD ABUSE / NEGLECT (CA/N) CENTRAL REGISTRY CLEARANCE
PRINT OR TYPE in black or blue ink. Additional information regarding the CA/N Central Registry is on the back of this form.
** See instructions for the address to use when submitting this form. **
Requesting Person or Agency/Organization
Check All That Apply
Mailing Address
Child Placing Agency
Residential Child Care Facility
Child Day / Night Care Center
Telephone Number (
)
Email:
Family Day / Night Care Home
PRINT Requestor’s Name
Exempt Child Day Care Center
Requestor
Date
Medicaid Rehab. Provider
Signature
DHR Vendor
Witness
Other (Please Specify)
_________________________________
The person whose name and identifying information, printed or typed below, will provide unsupervised care and
supervision of children as an
employee
volunteer
other. This person’s specific job/role is or will be:
_________________________________________________________________________________________________
Name _____________________________________________ Sex
Last First Middle
Male
Race ___________ DOB ___/___/______
Female
Current Mailing Address
__________________________________________________________________________
Alias, Maiden & Prior Married Name(s)
______________________________________________________________
Name & DOB of Spouse & Former Spouse(s)
_________________________________________________________
Name & DOB of Children / Stepchildren
Alabama counties where person has lived and/or worked
_________________________________________________
Attach additional pages as needed to provide all information requested above.
To be completed by person being cleared
I authorize the Alabama Department of Human Resources to release information contained in the Child Abuse / Neglect Central Registry about me to the above named person/agency/organization. I hereby waive any right to any review or hearing to which I may otherwise be entitled. I further release the Department of Human Resources, its officers, and employees from any and all claims arising out of or in any way connected to the release or dissemination of any information concerning me.
________________
Signature of Witness
To be completed by DHR
A search of the Alabama Child Abuse / Neglect Central Registry has been completed with the information provided to determine if the person identified above has been named as being responsible for child abuse or neglect in Alabama. DHR releases only that information which is necessary to discover or prevent child abuse / neglect.
Substantiated report (i.e., indicated) located. See attached information.
Type Report:
Physical Abuse
Neglect
Sexual Abuse
Mental Abuse / Neglect
No report located.
Request Denied
______________________________________________________________________________
Other _________________________________________________________________________________________
______________________________________
Office of Child Protective Services
Date Completed
DHR-FCS-1598 (Revised December 2009)
Alabama Mvt 41 1 - Applicant authorization for special mailing can be included when appropriate.
Alabama Ju 26D - The form protects the minor's identity throughout the appeal process.
Alabama Environment - Providers are encouraged to follow up with referrals included in the form.
The Alabama Central Registry Clearance form serves a critical function in ensuring the safety of children by checking for any history of child abuse or neglect. Similar to this form is the Child Protective Services (CPS) Background Check form. This document is used by CPS to assess whether an individual has any prior allegations or findings of abuse or neglect against children. Both forms require personal information, including names, addresses, and relationships to children. They also authorize the release of information, allowing agencies to make informed decisions regarding the safety and well-being of children in their care.
The Dirt Bike Bill of Sale form is a crucial document in New York that facilitates the legal transfer of ownership of a dirt bike from one party to another. This form provides essential details such as the buyer's and seller's information, a description of the bike, and the sale price. Ensuring both parties complete and retain a copy of this document can help prevent disputes and demonstrate proof of ownership. For those looking to obtain this form, resources such as PDF Templates Online can provide helpful templates and additional information.
Another comparable document is the National Sex Offender Registry (NSOR) Check. This form is utilized to determine if an individual is listed on the national database of sex offenders. Like the Alabama Central Registry Clearance form, it aims to protect vulnerable populations by screening individuals who may pose a risk. Both documents require consent from the individual being checked and are designed to provide peace of mind to organizations and families by ensuring that caregivers have no disqualifying offenses.
The Foster Care License Application is yet another document that shares similarities with the Alabama Central Registry Clearance form. This application is required for individuals seeking to become foster parents. It includes a comprehensive background check, including child abuse history, to ensure that potential foster parents are suitable caregivers. Both documents emphasize the importance of safeguarding children and involve a thorough review process to assess the fitness of individuals working with minors.
The Volunteer Background Check form is also relevant in this context. Organizations that work with children often require volunteers to undergo background checks to ensure a safe environment. This form, like the Alabama Central Registry Clearance form, collects personal information and authorizes a review of any criminal history, including child abuse. Both documents aim to mitigate risks by ensuring that only trustworthy individuals are allowed to interact with children.
Additionally, the Employment Background Check form is similar in purpose. Many employers, particularly those in childcare or educational settings, utilize this form to screen potential employees for any history of misconduct. Like the Alabama Central Registry Clearance form, it requires consent and provides a thorough examination of an individual’s background, focusing on any prior incidents that could jeopardize the safety of children.
Lastly, the Adoption Home Study Report shares commonalities with the Alabama Central Registry Clearance form. This report is a comprehensive assessment conducted to evaluate prospective adoptive parents. It includes background checks for any history of child abuse or neglect, ensuring that children are placed in safe and nurturing environments. Both documents are integral to the process of safeguarding children and require detailed personal information to facilitate thorough evaluations.
When filling out and using the Alabama Central Registry Clearance form, keep these key points in mind:
What is the purpose of the Alabama Central Registry Clearance form?
The Alabama Central Registry Clearance form is used to determine whether an individual has been named as responsible for child abuse or neglect in Alabama. This form is essential for individuals seeking employment or volunteer positions that involve unsupervised care of children. Organizations such as child care centers and residential facilities often require this clearance to ensure the safety and well-being of the children in their care.
Who needs to fill out this form?
The form must be completed by individuals who will provide unsupervised care and supervision of children, whether as employees, volunteers, or in other roles. This includes staff at child placing agencies, residential child care facilities, and day care centers. The requesting person or agency must also fill out their information on the form.
How should the form be completed?
The form should be filled out using black or blue ink. It requires detailed information about the individual being cleared, including their name, date of birth, current address, and any aliases. Additionally, the individual must authorize the Alabama Department of Human Resources to release information about them. It is important to ensure that all sections are completed accurately to avoid delays in processing.
What happens after the form is submitted?
Once the form is submitted, the Alabama Department of Human Resources will conduct a search of the Child Abuse/Neglect Central Registry based on the information provided. They will determine if there are any substantiated reports of abuse or neglect associated with the individual. The results will be communicated back to the requesting person or agency, indicating whether any report was located.
What if a report is found?
If a substantiated report of abuse or neglect is found, the agency will provide the necessary information about the nature of the report. This could include details such as the type of abuse, whether it was physical, sexual, or neglect. The individual may then need to address this information with the requesting agency, as it could impact their ability to work with children.
Can individuals contest the findings?
By signing the form, individuals waive their right to a review or hearing regarding the information released. This means that if a report is found, the individual cannot contest the findings through the Department of Human Resources. It is crucial for individuals to understand this before submitting their request.
Where should the completed form be sent?
Instructions for where to send the completed form are provided on the back of the form. It is important to follow these instructions carefully to ensure that the form reaches the appropriate department for processing. Failure to send it to the correct address could result in delays in obtaining the clearance.