Every individual submitting to a background screening must be provided with a summary of their Privacy Rights.
Please use the Background Submission Checklist, FBI-DCI Code List, and Fingerprint Card required boxes to ensure all forms are filled out correctly.
All applicants must submit a Central Registry screening request:
If you are a traditional provider, WDH supervisor or PHN supervisor, please include a Cover Sheet for Authorized Providers:
If you are an Employer of Record under the Self-Directed Waiver Program, please include a Cover Sheet for Self-Directed Care Providers:
- PDF Cover Sheet for Self-Direct Care Providers
- Fill-able Cover Sheet for Self-Direct Care Providers (Word)