The Alabama Central Registry Clearance form is a document used to request a background check regarding child abuse or neglect for individuals who will provide unsupervised care for children. This form is essential for ensuring the safety and well-being of children in various care settings, including day care centers and residential facilities. To begin the process, please fill out the form by clicking the button below.
The Alabama Central Registry Clearance form plays a crucial role in ensuring the safety and well-being of children in the state. Designed for individuals and organizations that provide unsupervised care, this form helps to determine if a person has any history of child abuse or neglect. By filling out this form, requestors can access vital information from the Alabama Department of Human Resources regarding the individual in question. The process involves providing personal details, including the applicant's name, date of birth, and any aliases, as well as the specific role they will undertake in caring for children. Additionally, the form requires the signature of the individual being cleared, allowing the Department to release necessary information while waiving any rights to review or hearing. This transparency is essential for maintaining trust and accountability in child care settings. Furthermore, the form includes sections for the Alabama Department of Human Resources to document the results of their search, indicating whether any substantiated reports of abuse or neglect exist. Understanding the importance of this form can empower caregivers and organizations to make informed decisions, ultimately contributing to a safer environment for children across Alabama.
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When navigating the process of obtaining an Alabama Central Registry Clearance, several other forms and documents may be required to support your application. These documents help ensure that all necessary information is collected and reviewed. Below is a list of commonly used forms that may accompany the Central Registry Clearance form.
Completing these forms accurately and submitting them alongside the Alabama Central Registry Clearance form can facilitate a smoother review process. It is essential to ensure that all required documentation is provided to avoid delays in obtaining clearance.
After completing the Alabama Central Registry Clearance form, it will be submitted to the appropriate department for processing. The information provided will be used to conduct a background check related to child abuse and neglect. Ensure all details are accurate to avoid delays in processing.
Misconceptions about the Alabama Central Registry Clearance form can lead to confusion and missteps in the application process. Here are seven common misunderstandings:
Understanding these misconceptions can help individuals navigate the Alabama Central Registry Clearance process more effectively. Awareness of the requirements and potential outcomes is essential for anyone involved in child care or related fields.
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)