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In the sphere of child welfare and safety, the Alabama Department of Human Resources Child Abuse/Neglect (CA/N) Central Registry Clearance form stands as a critical document, ensuring that individuals who provide unsupervised care, supervision, or volunteer work with children are meticulously vetted for any history of child abuse or neglect. By requiring complete and accurate information, including personal identifying details and a thorough history of residences and work in Alabama counties, this form enables a rigorous examination of an individual's background. The process is initiated by the requesting person or agency, covering various sectors such as child placing agencies, residential child care facilities, and various types of day or night care centers among others. Submitters must provide ink signatures, acknowledging the authorization of the Alabama Department of Human Resources to release any pertinent information from the CA/N Central Registry and waiving the right to any review or hearing process. This clearance form, detailed with requirements for information about spouses, former spouses, and children, underscores the state's commitment to safeguarding minors from potential harm. Upon submission, the Department conducts a search to determine if the person in question has been implicated in any verified incidents of child abuse or neglect within Alabama, a decisive step in fostering safer environments for children.

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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

 

 

 

Date

Other (Please Specify)

Signature

 

 

 

 

_________________________________

 

 

 

 

 

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

Date

Signature of Witness

Date

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)

Document Attributes

Fact Detail
1. Purpose The Alabama Central Registry Clearance form is designed to check if individuals have been identified as responsible for child abuse or neglect in Alabama.
2. Required Information Individuals must provide full name, sex, race, date of birth, current mailing address, alias or prior names, names and DOBs of spouse/former spouses and children/stepchildren, and Alabama counties where they have lived/worked.
3. Applicant Submission The form requires black or blue ink for filling out and includes a portion where the individual authorizes the release of information from the Child Abuse/Neglect Central Registry to the requesting entity.
4. Intended Use This form is used by various entities, including child placing agencies, residential child care facilities, day/night care centers, and others to ensure the safety of children under their care or supervision.
5. Waiver of Rights By signing the form, the individual waives any right to review or hearing related to the release of information from the Central Registry.
6. Release of Liability The form includes a provision that releases the Department of Human Resources, its officers, and employees from any claims arising from the release of information about the individual.
7. Results DHR will release information solely to prevent or identify child abuse/neglect, indicating whether a substantiated report exists or if no report is located.
8. Governing Law The clearance process is governed by Alabama laws pertaining to child protection, under the authority of the Alabama Department of Human Resources.

How to Fill Out Alabama Central Registry Clearance

Filling out the Alabama Central Registry Clearance form is a straightforward process that helps ensure the safety of children by screening individuals for any past incidents of child abuse or neglect. This form is used by various professionals and volunteers who are in positions to provide unsupervised care to children. Whether you're a daycare provider, a volunteer at a child care facility, or an employee at a child placing agency, completing this form accurately is vital. Below are the step-by-step instructions to guide you through the process.

  1. Use black or blue ink: Make sure to print or type all the information in either black or blue ink only. This ensures the form is legible and adheres to filing standards.
  2. Check the appropriate box: Identify yourself or your organization by checking the correct box that describes who is requesting this clearance (e.g., Child Placing Agency, Residential Child Care Facility, Child Day/Night Care Center, etc.).
  3. Provide mailing address and contact information: Fill in the mailing address where the response should be sent, along with your telephone number and email address to ensure any necessary follow-up.
  4. Print the Requestor’s Name and Date: Clearly print the name of the person or the name of the representative from the agency/organization requesting this clearance. Also, provide the date when this request is made.
  5. Add your signature and witness details: Sign the form to certify the information provided and have a witness sign it on the date indicated next to your signature.
  6. Fill in personal information for the person being cleared:
    • Type or print the full name, sex, race, and date of birth of the person under consideration.
    • Provide the current mailing address, any aliases, maiden, and prior married name(s).
    • List the name and date of birth of the spouse and former spouse(s), as well as children/stepchildren.
    • Include all Alabama counties where the person has lived and/or worked. If more space is needed, attach additional pages.
  7. Authorization by the person being cleared: The individual subject to the clearance must read and sign the authorization section, waiving their rights to a review or hearing related to the registry search and releasing the Department of Human Resources from any claims related to the release of this information. A witness must also sign and date this section.
  8. Submit the form: Review the form for completeness and accuracy. Once filled out, mail it to the address provided in the form's instructions, ensuring it reaches the intended department for processing.

After submission, the Alabama Department of Human Resources will conduct a search of the Child Abuse / Neglect Central Registry with the information you've provided. They will determine if there's any record matching the person being cleared. The result, detailing whether a substantiated report was located or not, helps in making informed decisions that protect children's welfare and safety. Remember, completing this form accurately and thoroughly is crucial for a smooth process.

More About Alabama Central Registry Clearance

  1. What is the Alabama Central Registry Clearance form?

    The Alabama Central Registry Clearance form is a document used by the Alabama Department of Human Resources to conduct searches in the Child Abuse and Neglect (CA/N) Central Registry. This search helps to determine if an individual has been identified as being responsible for child abuse or neglect in Alabama. It is typically required for individuals who will be providing unsupervised care and supervision of children in various settings, such as employees or volunteers at child placing agencies, residential child care facilities, day/night care centers, and other related organizations.

  2. Why is it necessary to complete the CA/N Central Registry Clearance form?

    Completing the CA/N Central Registry Clearance form is necessary to ensure the safety and well-being of children. By conducting a search in the Child Abuse and Neglect Central Registry, it helps to prevent individuals with a history of child abuse or neglect from being placed in positions where they would have unsupervised access to children. This is a precautionary measure to protect children from potential harm.

  3. Who should submit the CA/N Central Registry Clearance form?

    The form should be submitted by the individual or entity requesting the clearance, which can include child placing agencies, residential child care facilities, family day/night care homes, exempt child day care centers, Medicaid rehabilitation providers, DHR vendors, or any other organization that requires employees or volunteers to provide unsupervised care and supervision of children.

  4. What information is required on the form?

    The form requires detailed information about the person being cleared, including their full name, sex, race, date of birth, current mailing address, alias, maiden, and any prior married names. Additionally, information about the spouse, former spouses, children or stepchildren, and the Alabama counties where the person has lived or worked must be provided. The requester must also specify their relationship to the subject of the clearance (e.g., employee, volunteer) and their specific job or role.

  5. How can the form be submitted?

    The form should be printed or typed in black or blue ink and submitted to the address provided in the instructions. It is important to follow the instructions carefully to ensure the form is sent to the correct address for processing. The instructions section on the form will specify the mailing or physical address where the completed form should be sent.

  6. What happens after the form is submitted?

    After the form is submitted, the Alabama Department of Human Resources conducts a search of the CA/N Central Registry with the information provided. They will determine if the individual has been named in a substantiated report of child abuse or neglect. The department will then release only the necessary information to the requesting person or agency to prevent or discover child abuse or neglect.

  7. Can the person being cleared access the results?

    The person being cleared authorizes the release of information from the Central Registry to the named person or agency on the form and waives any right to review or hearing. While the clearance process is designed to protect children, the form does not specifically outline procedures for the individual being cleared to access the results directly. Typically, the requesting entity informs the individual about the outcome of the clearance.

  8. What does it mean if a "substantiated report" is located?

    If a substantiated report (indicated) is located, it means that the individual has been identified in the Child Abuse and Neglect Central Registry as being responsible for child abuse or neglect in Alabama. The specific type of abuse or neglect (physical, neglect, sexual, mental) will be indicated. This finding may impact the individual's ability to provide unsupervised care and supervision of children.

  9. What should be done if additional information needs to be provided?

    If additional information needs to be provided beyond what the form allows, attach additional pages as necessary. It is important to include all relevant information requested on the form to ensure accurate and comprehensive processing. Make sure that the supplemental information is clear, complete, and securely attached to the main form before submission.

Common mistakes

  1. Filling out the form in ink colors other than black or blue is a common mistake. The Alabama Department of Human Resources specifies that the form should be completed in black or blue ink only. This requirement ensures that the information is clearly legible and that the document can be copied or scanned without issues.

  2. Missing out on providing complete information about the requestor's role or the specific job/role of the person being cleared. This section is crucial for a thorough understanding of the context in which the individual will be interacting with children and specifies the capacity of their involvement, whether as an employee, volunteer, or other roles.

  3. Omitting alias, maiden, and prior married names can lead to an incomplete search of the Central Registry. Given that people might have records under different names, it's essential to list all known aliases or previous names to ensure a comprehensive background check.

  4. Not specifying all counties in Alabama where the person has lived and/or worked can result in an incomplete clearance. The form requires listing all such counties to facilitate a thorough search for any records of child abuse or neglect that might have occurred across the state.

  5. Failure to attach additional pages when more space is needed can lead to missing information. Often, the space provided on the form may not be sufficient to list all required details such as the complete names and dates of birth of children/stepchildren, and all the counties the person has resided or been employed in. This additional information is critical for a comprehensive clearance process.

Documents used along the form

In the process of ensuring the safety and well-being of children in Alabama, the Alabama Department of Human Resources Child Abuse/Neglect (CA/N) Central Registry Clearance form plays a crucial role. However, to provide a comprehensive background check or to fulfill various legal and procedural requirements, this form is often accompanied by several other documents.

  • Child Protective Services (CPS) Background Check Form: This form delves deeper into any interactions the individual may have had with child protective services beyond the scope of the CA/N Central Registry. It checks for any additional records that might not be listed in the registry.
  • FBI Fingerprint Background Check: This document requires the individual to submit fingerprints for a thorough national background check. It is key in revealing any criminal history that might disqualify them from working with or around children across all states, not just Alabama.
  • Drug Screening Consent Form: Often required for roles involving the care or supervision of children, this form grants permission for the individual to undergo drug testing. It is crucial for ensuring the safety and well-being of children under their care.
  • Declaration of Criminal History Form: On this form, the applicant must disclose any past criminal convictions or pending criminal charges. The declaration covers both misdemeanors and felonies, providing a self-reported criminal history.
  • Reference Check Form: This document is used to collect feedback from previous employers or professional references. It aims to verify the character and qualifications of the individual applying to work with children.

Together, these documents offer a multi-faceted view of an individual's background, enhancing the reliability of the screening process for those working with children. They serve as vital tools in protecting the most vulnerable members of the community by ensuring that only those with clear backgrounds are entrusted with their care and supervision.

Similar forms

  • FBI Background Check: Like the Alabama Central Registry Clearance form, the FBI Background Check requests comprehensive personal information to conduct a thorough search. It focuses on criminal history across all states, rather than specifically on child abuse or neglect cases, offering a wider scope of scrutiny for security clearances.

  • Criminal Record Check (State Level): Similar to the Alabama Clearance form, this document requests information to perform a search on an individual's criminal history within a specific state. It differs by encompassing all types of criminal activities, not just those related to child abuse or neglect.

  • Child Care Licensing Application: This application gathers personal details akin to the Alabama form for the purpose of licensing individuals or facilities providing child care services. It assesses suitability based on various criteria, including moral character and ability to provide safe care, paralleling the Alabama form’s aim to protect children's welfare.

  • Employment Verification Form: Though used for verifying previous employment, this form requires personal information and references similar to what is requested on the Alabama Clearance form. It serves to corroborate the capabilities and trustworthiness of individuals in a professional context.

  • Foster Parent Application: This application has parallels with the Alabama form in that it collects detailed personal information and background to assess the applicant's suitability for a sensitive role – in this case, caring for foster children. It includes checks on past instances of abuse or neglect as part of its scrutiny.

  • Volunteer Application for Child-Oriented Organizations: Organizations use this form for screening volunteers who will work closely with children, requiring detailed personal information and often consent to background checks, akin to the Alabama form's objectives of ensuring child safety and welfare.

  • Teacher Certification Background Check: Required for certifying educators, this check parallels the Alabama form by demanding personal information to screen for any history of misconduct, including child abuse or neglect, that could disqualify a candidate from working with children in an educational setting.

  • Immigration Visa Application: While its primary focus is not on child welfare, this application collects exhaustive personal details, similar to the Alabama form, as part of its background check process to maintain national security and public safety.

  • Professional License Application: Similar to the Alabama Clearance form, this application requires detailed personal information and background checks for individuals seeking licensure in fields like law, medicine, or real estate, focusing on ensuring the integrity and reliability of professionals.

  • Adoption Application: This form gathers extensive personal information and consent for background checks, closely mirroring the Alabama form’s process. Its purpose is to safeguard the welfare of children by thoroughly vetting the suitability of prospective adoptive parents.

Dos and Don'ts

When filling out the Alabama Central Registry Clearance form, it is crucial to ensure that all information provided is accurate and complete to facilitate a smooth processing experience. Below are lists of the recommended do's and don'ts to guide you through this process:

Things you should do:

  • Use black or blue ink to fill out the form, ensuring that all written information is legible and easy to read.

  • Thoroughly read the additional information provided on the back of the form before beginning to fill it out. This can offer valuable guidance.

  • Check the appropriate boxes that apply to the person or agency/organization requesting the clearance.

  • Include the requestor's name, mailing address, and telephone number, ensuring no details are left out.

  • Clearly print the name, date of birth, and current mailing address of the person being cleared, as these are crucial for the search in the registry.

  • Sign and date the authorization section at the bottom of the form to allow the Department of Human Resources to release the necessary information.

  • Attach additional pages if needed to ensure all relevant information is provided. This includes detailing all Alabama counties where the person has lived and/or worked.

  • Ensure the accuracy of all provided information to prevent any delays or issues with the registry clearance process.

Things you shouldn't do:

  • Don't fill out the form in any ink color other than black or blue to avoid processing delays.

  • Don't skip reading the supplementary information available on the back of the form, as it can clarify important details and procedures.

  • Avoid leaving any required field blank. If a section does not apply, indicate that appropriately.

  • Don't neglect the necessity to check all boxes that apply to your request accurately, as missing information can lead to incomplete processing.

  • Refrain from using aliases without listing them in the designated section, along with maiden or prior married names, to prevent inaccuracies in the registry search.

  • Do not forget to sign the form both by the person requesting the clearance and the person who is being cleared.

  • Don't attach unnecessary documents that are not explicitly required by the form to avoid confusion and processing delays.

  • Avoid giving false or misleading information, as this could lead to legal consequences or hindrances in process completion.

Misconceptions

Understanding the Alabama Central Registry Clearance form requires clarity on some common misconceptions. Here’s an attempt to demystify these for better comprehension:

  • Misconception #1: "This form is an extensive background check."

    Actually, the form specifically checks for substantiated reports of child abuse or neglect recorded in the Alabama Child Abuse/Neglect Central Registry. It does not cover other aspects of a person's background or criminal history.

  • Misconception #2: "Anyone can request this clearance."

    In truth, the request must be made by or for a person or entity involved in the care, supervision, or custody of children, such as child placing agencies, child care facilities, and certain health providers. Personal or unrelated third-party requests are not permitted.

  • Misconception #3: "A denied request means a person has a criminal record."

    A denial or a substantiated report solely indicates findings of child abuse or neglect in the Central Registry. It does not reflect on the individual’s criminal record outside of this specific context.

  • Misconception #4: "Submitting an application guarantees clearance."

    Submission only initiates the process. Clearance will depend on the absence of relevant reports in the registry. Even if there's no history of abuse or neglect, processing times and accurate form completion also factor into obtaining clearance.

  • Misconception #5: "Clearance is valid indefinitely."

    Clearance reflects a moment-in-time search of the registry and is not an ongoing certification. If circumstances change or new information arises after the clearance is issued, it does not remain valid indefinitely.

Understanding these key points helps in accurately navigating the requirements and implications of the Alabama Central Registry Clearance form, leading to more informed and effective use in safeguarding the well-being of children under care or supervision.

Key takeaways

Filling out and using the Alabama Central Registry Clearance form is crucial for those involved in childcare or similar roles. Here are five key takeaways:

  1. The form must be filled out using black or blue ink, ensuring that the handwriting is legible or typed to avoid any delays or misunderstandings in processing.
  2. It is essential to provide complete and accurate information about the individual seeking clearance, including any aliases, maiden, and prior married names to ensure a thorough search in the Child Abuse/Neglect (CA/N) Central Registry.
  3. The form requires information about the person's job/role in providing unsupervised care and supervision of children, underlining the importance of defining the specific nature of the employment or volunteer work.
  4. Authorization and waiver of rights are necessary parts of the form. The individual being checked must sign, indicating they authorize the release of information from the CA/N Central Registry and waive their right to a review or hearing. This step is pivotal, as it allows the Alabama Department of Human Resources to release necessary information related to child abuse or neglect.
  5. After submission, the Alabama Department of Human Resources will conduct a search and release information only if it is deemed necessary to discover or prevent child abuse or neglect. The response will indicate whether any substantiated report concerning the individual was located or if no report was found, ensuring that children are placed in safe environments.

To ensure a smooth and efficient processing of the Alabama Central Registry Clearance form, it is critical for individuals and agencies to follow these guidelines carefully. Successfully navigating this process is an important step in safeguarding the welfare of children in various care settings across Alabama.

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