Licensing - HSLIC

Background Screening Application

The background screening applications can be acquired from the Licensee Representative or downloaded:

Background Screening Application is downloaded here

Background Screening FOSTER CARE Application is downloaded here

Background Screening YOUTH Application is downloaded here

Exemption Declaration is downloaded here

Instructions for completing the application are located here

Remember these important points when filling out your application:

Incomplete or unreadable applications will be returned unprocessed.
Current general background screening application with revision date of September 2015. Any submitted applications with a revision date prior to September 2015 will be returned unprocessed.

Current foster care background screening application with a revision date of February 2016. Any submitted applications with a revision date prior to February 2016 will be returned unprocessed.

Each section must be completed by the appropriate party.  Each section must be legible.
Include legal first name, given middle name (not maiden name), current legal last name, alias, maiden and previously married names.
Answering YES to questions #2, #3, or #4  requires additional documentation.  See each question for clarification or requirements.
  If charged with a crime, the certified court docket showing final disposition must be provided at the time of application. If pending charge, provide certified court docket showing hearing date.
Initial applicants must provide two complete hard-copy fingerprint cards with cashier’s check, money order or company check for appropriate amount made payable to the Department of Human Services.
Completed applications must be mailed to the Office of Licensing.  
Please observe a two-week time period before requesting the status of submitted applications.
If an applicant is no longer associated with your facility, please fax us a notice on your company letterhead to the Background Screening Unit FAX: 801-538-4669.
Please contact your licensor for any changes to your mailing address or facility name.

New Changes to Office of Licensing Background Screening and How it Affects You

September 1, 2015

Who needs to fill out the new Screening Application form?

  • All applicants for either an initial or renewal screening will use the new application form.
  • There is also a box for “transfer” applicants on the form that will be utilized once rule is written.

Who uses the form that designated as for foster homes?

  • Only licensed foster/adoptive families or those certified by a child placing agency to do foster/adoptive care for a child placing agency (includes proctor, professional –essentially all those that require Adam Walsh compliance)
  • Private adoption agencies will NOT use the foster/adopt form. They will use the general form.

What is the fingerprint background subscription that the form refers to?

  • A subscription means that the fingerprints are retained and that the Office of Licensing will receive ongoing feedback on new criminal behavior–not just once a year at renewal time.

What is the difference between the $39.75 subscription and the $52.75 Rap Back subscription?

  • $39.75 includes an ongoing subscription in the eight WIN states (Utah, Washington, Oregon, Idaho, Montana, Wyoming, Alaska or Nevada), in addition to an initial FBI check. It is sufficient to meet the new statutory requirements unless the person is likely in the future to spend a lot of time outside of the WIN states. This check also includes an initial, one time, nationwide FBI check. So, if people have lived out of the state previously, but now live in and have ID from the eight WIN states, then this check is most likely the one for them.
  • $52.75 includes an ongoing, nationwide FBI subscription. This must be used for anyone who lives outside of the WIN states, uses state identification from outside of the WIN states, or reports that they will spend substantial time outside the WIN states in the future.
  • The full FBI check for $52.75 provides the highest level of protection. This option is available to ALL applicants and we encourage providers to choose this standard even if the applicant is a resident of a WIN state that is unlikely to spend substantial time outside the WIN states. This provides the best standard in ongoing criminal background screening and may reduce your agency’s liability.

Who needs to submit fingerprints and fees?

  • New applicants doing initial screening forms will need to submit fingerprints
  • Renewal applicants (those with a current screening on file with the Office of Licensing prior to September 1, 2015) only need to submit fingerprints if they live in or use identification that is not issued by a WIN state.

This is going to require our agency to submit a lot more prints, can we roll them ourselves?

  • Fingerprints must be rolled by individuals trained in the methods used by law enforcement agencies.  Ink pads (FPT265) or print over tabs (FPT107R or FPT108R) may be ordered at  Fingerprint cards must be ordered directly from Department of Public Safety, BCI, 801-965-4445, opt 6.

You used to have a fillable Background Screening application online, how come you don’t now?

Why doesn’t it ask me if I have been outside of the state for six weeks or outside of the country?

  • Office of Licensing has determined that since everyone will have a full FBI check with their initial application, that these questions are no longer needed.

I have heard about a way to “transfer” fingerprints from one agency to another, as well as a “conditional approval” process. Can you tell me more?

  • It is accurate that there are other enhancements and changes to background screenings. We are working on a rule update that will be in place this fall.
  • If you have an applicant who has already submitted prints, the new application, and the new fee after September 1, 2015, that is transferring agencies,  please contact your background screening technician directly to coordinate a transfer of that fingerprint background subscription.

If you have further questions, do not hesitate to call us at 801-538-4242.