Attachment 8 - DCFS Authorization for Background Check


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Attachment 8 - DCFS Authorization for Background Check (pdf)


Text on the form:
CFS 689
6/2001

State of Illinois
Department of Children and Family Services

AUTHORIZATION FOR BACKGROUND CHECK
Child Abuse and Neglect Tracking System (CANTS)

For Programs NOT Licensed by DCFS

NOTE: Do not use this form if you are an applicant for licensure or an employee/volunteer of a licensed child care facility. Please contact your licensing representative.

  • Name: (Last, First, Middle)
  • Date of Birth:
  • Gender (circle): Male Female
  • Race:
  • Current Address: (Street/Apt #, City, State, Zip Code)
  • List all addresses at which you have resided in the past five years:
  • List maiden name and/or all other names by which you have been known: (last, first, middle)
  • I hereby authorize the Illinois Department of Children and Family Services to conduct a search of the Child Abuse and Neglect Tracking system (CANTS) to determine whether I have been a perpetrator of an indicated incident of child abuse and/or neglect or involved in a pending investigation. I further consent to the release of this information to the agency listed below.
  • Signed Date
  • Please type, use bold letters or label:
    • (Agency Name)
      (Contact Person)
      (Address)
      (City/State/Zip)
  • Mail this request to:
    Department of Children and Family Services
    406 E. Monroe
    Station # 30
    Springfield, IL 62701

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