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The DPHHS QAD CRL 18 form plays a crucial role in the process of conducting background checks for individuals seeking employment or volunteer opportunities within adult and youth care facilities in Montana. This form is designed to gather essential personal information, including the legal name, aliases, and contact details of the applicant. It requires individuals to disclose their residential history over the past five years, particularly if they have lived in other states or on Indian reservations. Such disclosures are vital as they may necessitate additional background checks, which the applicant must obtain at their own expense. Furthermore, the form addresses the applicant's current employment status, asking for details about the facility where they work or reside. An important aspect of the form is the authorization statement, where applicants acknowledge that their information will be shared with the Montana Department of Public Health and Human Services for the purpose of reviewing their background. This section also highlights the potential implications of any findings related to child abuse or neglect, criminal history, or motor vehicle records. Understanding the requirements and implications of the DPHHS QAD CRL 18 form is essential for anyone navigating the background check process in these sensitive environments.

Common mistakes

  1. Incomplete Personal Information: Failing to fill out all required fields, such as phone number or social security number, can lead to processing delays.

  2. Incorrect Legal Name: Providing a name that does not match official documents can cause issues. Ensure that the name is consistent with identification.

  3. Missing Past Residences: Not listing all places of residence within the last five years may result in incomplete background checks.

  4. Omitting Aliases: Failing to include any aliases or other names used can hinder the background check process. It’s important to provide all variations of your name.

  5. Neglecting to Complete Both Sides: Not filling out both sides of the form can lead to immediate rejection of the application.

  6. Authorization Statement Errors: Incorrectly completing the authorization statement or signature section may invalidate the form.

  7. Signature Issues: Not signing in front of a notary public can result in the form being considered incomplete. The signature must be properly notarized.

  8. Ignoring Instructions: Not following specific instructions provided on the form can lead to confusion and potential denial of the application.

Dos and Don'ts

When filling out the DPHHS QAD CRL 18 form, there are several important dos and don'ts to keep in mind. Following these guidelines can help ensure your application is processed smoothly.

  • Do provide accurate personal information, including your legal name and social security number.
  • Do check all boxes that apply to your residency and employment status.
  • Do sign the form in front of a notary public to ensure your signature is valid.
  • Do complete both sides of the form to avoid delays in processing.
  • Don't leave any sections blank; incomplete forms may be rejected.
  • Don't use nicknames or aliases unless specified; stick to your legal name.
  • Don't forget to provide your mailing address if it differs from your residential address.
  • Don't submit the form without reviewing it for errors or omissions.

Similar forms

The DPHHS QAD CRL 18 form is similar to the Employment Background Check Authorization form, commonly used by employers to verify a candidate's history before hiring. Both documents require the applicant to provide personal information, such as name, address, and social security number. They also include sections for previous residences and employment history, ensuring that the employer can conduct a thorough background check. The primary purpose of both forms is to safeguard the workplace by identifying any potential risks associated with hiring a new employee.

Another related document is the Child Abuse Background Check form, which is essential for individuals working with children. Like the DPHHS QAD CRL 18, this form collects personal information and details about past residences. The focus, however, is specifically on identifying any history of child abuse or neglect. Both forms aim to protect vulnerable populations by ensuring that individuals with a history of harmful behavior are not placed in positions of trust.

Understanding the significance of various legal documents, such as the DPHHS-QAD/CRL-18, is crucial. In fact, much like a Last Will and Testament, which allows individuals to dictate the management of their assets and the care of minor children after death, these forms play a vital role in safeguarding interests and ensuring responsibilities are clearly defined. For more information on important legal documents, visit TopTemplates.info.

The Criminal History Record Check form serves a similar purpose, focusing on criminal background information. This document is often required by various organizations, including schools and healthcare facilities. Both the Criminal History Record Check and the DPHHS QAD CRL 18 form require consent from the individual for the release of sensitive information. They both help organizations make informed decisions about the suitability of individuals for specific roles, particularly those that involve significant responsibility.

The Volunteer Background Check Authorization form is another document that aligns closely with the DPHHS QAD CRL 18 form. This form is specifically designed for volunteers who may work with children or vulnerable adults. It collects similar personal information and requires the applicant's consent for background checks. Both forms emphasize the importance of ensuring that individuals in volunteer positions do not pose a risk to those they serve.

The Release of Information form is also comparable, particularly in its purpose of granting permission for organizations to access an individual’s personal records. This form, like the DPHHS QAD CRL 18, requires the applicant to provide detailed personal information. Both documents ensure that the release of confidential information is authorized and legally compliant, protecting both the individual and the organization involved.

The State Licensing Application is another document that shares similarities with the DPHHS QAD CRL 18 form. This application often requires background checks as part of the licensing process for various professions, such as healthcare providers and educators. Both forms demand comprehensive personal information and consent for background checks, highlighting the importance of safety and trust in regulated professions.

Additionally, the Motor Vehicle Record Check form is relevant, especially for positions that involve driving. This document, like the DPHHS QAD CRL 18, collects personal information and requires consent to access driving records. Both forms are critical in evaluating an individual’s qualifications and ensuring that they meet the necessary standards for their roles.

Finally, the Professional License Verification form is similar in that it often requires background checks as part of the verification process. This form gathers personal and professional information, much like the DPHHS QAD CRL 18. Both documents serve to confirm the qualifications and integrity of individuals seeking to work in regulated fields, ensuring that only those who meet the required standards are granted access to sensitive roles.

Instructions on How to Fill Out Dphhs Qad Crl 18

Once you have gathered all necessary information, you can begin filling out the DPHHS QAD CRL 18 form. It’s important to be thorough and accurate, as any mistakes could delay the process. Follow these steps carefully to ensure your form is completed correctly.

  1. Start with Section A. Fill in your phone number and legal name (first, middle, maiden, last).
  2. List any aliases or other names used.
  3. Provide your residential address (street, city, state, zip).
  4. Fill in your mailing address (if different from your residential address).
  5. Indicate your sex by checking the appropriate box.
  6. Enter your date of birth and social security number.
  7. Move to Section B. Answer the questions regarding past residences within the last five years.
  8. If you answered "yes" to either question, complete the table with your city, county, reservation, state, and dates of residency.
  9. In Section D, provide the name of the facility you are working or living at.
  10. Fill in the director name and facility mailing address.
  11. In Section E, read the authorization statement carefully.
  12. Sign your name and date the form. Ensure that you sign it in front of a notary public.
  13. Leave the section for the notary public to complete blank for them to fill out later.

Documents used along the form

The DPHHS QAD CRL 18 form is essential for background checks in adult and youth care facilities. Along with this form, several other documents are often required to ensure a comprehensive review of an individual's background. Below is a list of these documents, along with a brief description of each.

  • Background Check Authorization Form: This form grants permission for employers to conduct background checks, including criminal history and other relevant records.
  • Employment Application: This document provides detailed information about the applicant’s work history, education, and qualifications for the position.
  • Identity Verification Documents: These may include a driver's license, passport, or state ID to confirm the applicant's identity and address.
  • Social Security Card: A copy of the applicant's Social Security card is often required to verify their Social Security number.
  • Child Abuse and Neglect Background Check Form: This form specifically requests information regarding any history of child abuse or neglect allegations against the applicant.
  • Motor Vehicle Record Request Form: This document requests the applicant's driving history, which is important for positions requiring driving responsibilities.
  • Release of Liability Form: This form is crucial for protecting parties involved in activities that carry risks, ensuring participants acknowledge their acceptance of these risks. For more information, visit smarttemplates.net/fillable-california-release-of-liability.
  • Reference Check Form: This form is used to collect feedback from previous employers or personal references regarding the applicant’s character and work ethic.
  • Notary Acknowledgment: A notarized statement confirming the authenticity of signatures on various forms may be required to ensure legal compliance.

Each of these documents plays a crucial role in the background check process, helping to ensure the safety and integrity of care facilities. It is important to prepare and submit all required forms accurately to avoid delays in the application process.

Misconceptions

Misconceptions about the DPHHS QAD CRL 18 form can lead to confusion and delays. Here are nine common misunderstandings:

  • It is only for employees. Many believe this form is exclusively for employees. In reality, it also applies to volunteers and household members associated with care facilities.
  • Only criminal background checks are conducted. Some think the form is solely for criminal checks. It actually includes checks for child abuse or neglect reports and motor vehicle records as well.
  • Filling out the form guarantees approval. Completing the form does not ensure that an application will be accepted. Any negative findings in the background check can lead to denial.
  • Only Montana residents need to fill it out. People often assume that only those living in Montana need to submit this form. However, individuals who have lived in other states or on Indian reservations in the last five years must also comply.
  • Information provided remains confidential. Many believe that once the information is submitted, it will always remain confidential. While the requesting entity is bound to protect it, DPHHS cannot guarantee confidentiality after the information is released.
  • Notarization is optional. Some individuals think notarization is not necessary. In fact, the form must be signed in front of a notary public to be valid.
  • Only personal information is required. There is a misconception that only personal details matter. The form also requires information about past residences and employment status, which are critical for background checks.
  • Past criminal history is irrelevant if it’s old. Many people believe that older offenses won’t affect their application. However, any substantiated reports or records, regardless of age, may still be considered.
  • Submitting incomplete forms is acceptable. Some individuals think they can submit the form even if it’s not fully completed. Incomplete submissions can lead to application denial.

Understanding these misconceptions can help streamline the process and ensure compliance with the requirements of the DPHHS QAD CRL 18 form.

Example - Dphhs Qad Crl 18 Form

DPHHS-QAD/CRL-18 (Revision 3-10)

DEPARTMENT OF

PUBLIC HEALTH AND HUMAN SERVICES

STATE OF MONTANA

- RELEASE OF INFORMATION -

For Adult and Youth Care Facility Providers

Criminal / Protective Service / Motor Vehicle

Background Checks

PERSONAL INFORMATION

Section A – Current Information

Phone # ________________________

Legal Name: ______________________________________________________________________________________

(First)(Middle)(Maiden)(Last)

Aliases/Other Names Used: __________________________________________________________________________

Residential Address: ________________________________________________________________________________

(Street)(City) (State ) (Zip)

Mailing Address: ___________________________________________________________________________________

 

 

 

 

 

 

(Street)

 

 

(City)

(State )

(Zip)

 

 

Sex: [

] Male

[ ] Female

Date of Birth: _________________

Social Security #_________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section B – Past Residences

 

 

 

 

 

 

 

 

 

 

 

 

Within the last five (5) years, have you…

 

 

 

 

 

 

 

 

1.

…lived in another state?

 

 

 

 

[

] Yes

[

] No

 

 

2.

…lived on or do you now live in an area designated as an Indian reservation?

[

] Yes

[

] No

 

 

 

If you answered yes to the any of the above questions:

 

 

 

 

 

 

 

 

 

 

Please state where you have lived since turning 18 in the table below.

 

 

 

 

 

 

 

 

You will need to obtain an out of state background check or a tribal background check at your cost.

 

 

 

 

City

 

 

 

County

 

Reservation

State

Dates of Residency (From – To)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section D – Employment Status

The facility that I am working / living at is:

Director Name / Facility Name: ___________________________________________________________________

Facility Mailing Address: ________________________________________________________________________

PLEASE COMPLETE BOTH SIDES OF THIS FORM

Section E – Authorization Statement and Signature

I, ____________________ (applicant name), am aware that __________________________________ (provider or its

authorized representative), has requested confidential information from the Montana Department of Public Health and Human Services, in accordance with 41-3-205(3)(o), MCA as part of a review of my personal background in connection with my status as a current or prospective employee of or volunteer for that entity.

I am aware that CFSD, DMV, and DOJ records may contain information that could adversely affect my employment or volunteer status and/or approval as outlined in ARM 37.95.161 and ARM 37.95.176. These records will relate to any substantiated report(s) of child abuse or neglect in Montana, criminal history records, and motor vehicle records. As a household member, I understand that I am also subject to the above requirements.

I am also aware that although the entities or individuals requesting and receiving confidential CFSD information are bound by law or agreement with DPHHS to protect or preserve its confidential nature, DPHHS has no ability or authority to ensure that confidentiality is maintained after this information is released by DPHHS.

In full acknowledgement of the above information and notice, I authorize CFSD to provide the requested confidential information to__________________________________________ (provider or its authorized representative), and I

hereby also release CFSD from any claims or causes of action which may subsequently arise from release of this confidential information.

NOTE: Any deletions or oversights may result in the denial of your application.

Signed: _______________________________________________________________ Date: ____________________

(To be signed in front of a notary)

TO BE COMPLETED BY A NOTARY PUBLIC:

Taken, sworn, and subscribed before me this ____________ day of _________________________ A.D. ____________

_________________________________________________________

Notary Public for the State of Montana

Residing at: _______________________________________________

My commission expires: _____________________________________

Understanding Dphhs Qad Crl 18

What is the purpose of the DPHHS QAD CRL 18 form?

The DPHHS QAD CRL 18 form is designed to facilitate background checks for individuals applying to work or volunteer in adult and youth care facilities in Montana. This form allows the Department of Public Health and Human Services (DPHHS) to gather necessary personal information and authorize the release of confidential records related to criminal history, child abuse or neglect reports, and motor vehicle records. Completing this form is a crucial step in ensuring the safety and well-being of individuals in care facilities.

Who needs to complete the DPHHS QAD CRL 18 form?

Any individual seeking employment or volunteer opportunities at an adult or youth care facility in Montana must complete this form. This includes not only prospective employees but also household members of those applying. The form is essential for anyone whose background may impact their ability to work with vulnerable populations.

What information is required on the form?

The form requires several key pieces of information, including:

  • Legal name and any aliases or other names used
  • Current residential and mailing addresses
  • Date of birth and Social Security number
  • Details of past residences over the last five years, particularly if lived in another state or on an Indian reservation
  • Employment status, including the name and address of the facility where the individual is applying to work or volunteer

Completing all sections accurately is vital, as any omissions may lead to application denial.

What happens after submitting the DPHHS QAD CRL 18 form?

Once the form is submitted, the DPHHS will process the request and conduct the necessary background checks. This includes reviewing records related to criminal history and any substantiated reports of child abuse or neglect. The results of these checks will determine the individual's eligibility for employment or volunteer status at the facility. It is important to note that the processing time may vary, so applicants should plan accordingly.

Is there a cost associated with obtaining background checks?

Yes, applicants may incur costs for obtaining background checks, especially if they have lived in other states or on tribal reservations. The form advises that individuals will need to cover these expenses themselves. It is advisable to check with the relevant agencies for specific fees and procedures related to out-of-state or tribal background checks.