Screening Authorization/Consent Form - Cornell Cooperative Extension Charges will be fairly assessed by the Office of Licensing as described in state law, A licensed program shall not be provided the details of any applicants screenings nor can they disclose screening results except as authorized by Utah or federal law. Steps for Entering a Youth Application in DACS, Exemption Declaration (adult substance abuse treatment programs only), Contact Information for obtaining an out of state Central or Child Abuse Registry Check, I understand that my personal information including name, date of birth, social security number and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. Help; \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-3. If you believe a background check has been triggered for some other than the reasons listed above, contact HR Records at hrsc-records@austin.utexas.edu or 512-471-4772. 1395i-4(c)(2). Box 570, Jefferson City, MO, 65102. \par \tab \hich\af5\dbch\af31505\loch\f5 (a) Signs a criminal background screening authorization form which must be available for review by the department; and Salt Lake City, UT 84116. \par \tab \hich\af5\dbch\af31505\loch\f5 (3) If the Department determines an individual is not eligible for direct patient access based upon the non-criminal background screening and the ind\hich\af5\dbch\af31505\loch\f5 Employment Background Checks Forms - DPS - Criminal Identification (BCI) \par }}{\*\aftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid14438297 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\af5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 { \par \tab \hich\af5\dbch\af31505\loch\f5 (viii) housekeeping; How do I Apply for a Concealed Firearm Permit? \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Grid 7;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Grid 8;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 1;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table List 2; Utah Admin. Code R432-35-5 - Covered Contractor - DACS Process 0f88d94fbc52ae4264d1c910d24a45db3462247fa791715fd71f989e19e0364cd3f51652d73760ae8fa8c9ffb3c330cc9e4fc17faf2ce545046e37944c69e462 \par \tab \hich\af5\dbch\af31505\loch\f5 (14) "Patient" means an individual who receives health care services from one of the following covered provid\hich\af5\dbch\af31505\loch\f5 ers: With the required release and proper payment, all adult arrest records are released. 13) of the Utah State Bulletin. Child Abuse/Neglect One-time adoptions submitted by a non-licensed entity (adoption attorney, etc.) \par \tab \hich\af5\dbch\af31505\loch\f5 (a) means an individual: \par \tab \hich\af5\dbch\af31505\loch\f5 (2) A covered contractor must ensure that the covered individual, being supplied by contract to a covered provider\hich\af5\dbch\af31505\loch\f5 : {\fdbmajor\f31518\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbmajor\f31519\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbmajor\f31521\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;} \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 KEY: health care facilities, background screening}{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 PDF UTAH DEPARTMENT OF HEALTH Medical Cannabis Production Establishment Criminal Searches, Instant People Check: Background check includes (7) The Department may allow a covered individual direct patient access with conditions, during an appeal process, if the covered individual can demonstrate the work arrangement does not pose a threat to the safety and health of patients or residents. \par \tab \hich\af5\dbch\af31505\loch\f5 (b) Submits fingerprints within 15 working days of engagement. Only agencies with OL administrative approval and a documented exception to live scan fingerprinting will be allowed to submit hard card prints rolled at a public safety office. {\f870\fbidi \froman\fcharset204\fprq2 Cambria Math Cyr;}{\f872\fbidi \froman\fcharset161\fprq2 Cambria Math Greek;}{\f873\fbidi \froman\fcharset162\fprq2 Cambria Math Tur;}{\f876\fbidi \froman\fcharset186\fprq2 Cambria Math Baltic;} No appeal is available if you are denied for failure to provide required information, If you close your foster care license, it is your or the screening agents responsibility to inform the Office of Licensing for removal from the ongoing Rap Back system, You are required to disclose all criminal charges, including pending charges, and all supported or substantiated findings of abuse, neglect or exploitation. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Web 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Balloon Text;\lsdpriority39 \lsdlocked0 Table Grid;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Table Theme;\lsdsemihidden1 \lsdlocked0 Placeholder Text; (a) Signs a criminal background screening authorization form which must be available for review by the department; and (b) Submits fingerprints within 15 working days of engagement. \s24\ql \li720\ri720\sl240\slmult0\nowidctlpar\tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 195 North 1950 West ;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'02. Multi-Agency State Office Building \lsdpriority48 \lsdlocked0 Grid Table 3 Accent 1;\lsdpriority49 \lsdlocked0 Grid Table 4 Accent 1;\lsdpriority50 \lsdlocked0 Grid Table 5 Dark Accent 1;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful Accent 1; Section R432-35-4 - Covered Provider - DACS Process (1) Covered providers shall enter required information into DACS to initiate a clearance for each covered individual prior to issuance of a provisional license, license renewal or engagement as a covered individual. SUBJECT: Memorandum Report: State Requirements for Conducting Background Checks on Hom e Health Agency Employees, OEI-07-14-00131 In response to a congressional request, the Office oflnspector General (OIG) initiated two . \par \par \tab \hich\af5\dbch\af31505\loch\f5 (b) is not a covered provider; and b01d583deee5f99824e290b4ba3f364eac4a430883b3c092d4eca8f946c916422ecab927f52ea42b89a1cd59c254f919b0e85e6535d135a8de20f20b8c12c3b0 RULE ANALYSIS Purpose of the rule or reason for the change: The purpose of this new rule is to outline the process for the background screening of Department of Health (Department) employees. Medical Cannabis Production Establishment Agent Criminal Background Screening Authorization Form First Name: Last Name: I understand that my personal information including name, DOB, SSN and fingerprints will be used for the purpose of conducting a criminal history records search through any applicable state and federal databases. Upon receipt of an official communication from the agency with control over the data, the FBI will make appropriate changes and notify you of the outcome. Human Services Program Forms. {\flomajor\f31514\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flomajor\f31515\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flomajor\f31516\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);} 1-800-273-TALK(8255) provide personal demographics required; and iii. A face covering or mask is recommended for anyone being fingerprinted. Background Screening FAQ. Bringing our agencies together helps us better serve Utahns with a more effective, seamless system of services and programs so everyone in Utah has the opportunity to live safe and healthy lives. ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff Employment/Volunteer Background Checks | DPS - Criminal Identification \par \tab \hich\af5\dbch\af31505\loch\f5 (d) a hospice that provides living quarters as part of its services. }{\rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 3f2451eced0dae2c082e8761be9969bb979dc9136332de3168aa1a083ae995719ac16db8ec8e4052164e89d93b64b060828e6f37ed1567914b284d262452282e 432KB Noncriminal Justice Applicant's Privacy Rights Form 1081 Form Instructions 177KB Health Care Mississippi Background Check 192KB Regular Mississippi Background Check 171KB Applicants Living in Another State 169KB AHCA:Central Services: Background Screening - Florida Background Screening Unit. The following forms are for those authorized entities seeking to obtain criminal history information on employees or volunteers. I-9, Employment Eligibility Verification - Home | USCIS \par \tab \hich\af5\dbch\af31505\loch\f5 (i) types and number; Covered Individuals with Arrests or Pending Criminal Charges. (a) Results of background screening review, as listed above in R432-35-8(1), (2), and (3), may be reviewed to determine under what circumstance, if any, the covered individual may be granted or retain direct patient access. We have transtioned to DACS (Direct Access Clearance System), a completely online background screening system. \par \tab \hich\af5\dbch\af31505\loch\f5 (2) if significant problems exist that result in actual harm to a resident, the department may impose a civil penalty of $1,050 to $10,000 per day. : 43003 Filed: 06/15/2018 10:31:45 AM RULE ANALYSIS Purpose of the rule or reason for the change: The Utah Department of Health and Human Services is now one agency. The FBI is responsible for the storage of fingerprints and related Identity History Summary information for the nation and does not have the authority to modify any Identity History Summary information unless specifically notified to do so by the agency that owns the information. corresponding number and place in the Caregivers Criminal History Screening Program Authorization For Release of Information. Before a determination is made, I understand that I will be afforded a reasonable amount of time to challenge the completeness and accuracy of the record through the procedures established by the Department of Human Services, Office of Licensing as well as contacting the Utah Bureau of Criminal Identification (Utah Criminal History Results), the State Identification Bureau (SIB) associated with any results that are outside of Utah, or the Federal Bureau of Investigation (Nationwide Criminal History Response Information). \lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 2;\lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 3;\lsdsemihidden1 \lsdunhideused1 \lsdqformat1 \lsdpriority9 \lsdlocked0 heading 4; \par \tab \hich\af5\dbch\af31505\loch\f5 (b) juvenile court arrest, adjudication, and disposition records, as allowed under Section 78A-6-209; 656e74323d22616363656e74322220616363656e74333d22616363656e74332220616363656e74343d22616363656e74342220616363656e74353d22616363656e74352220616363656e74363d22616363656e74362220686c696e6b3d22686c696e6b2220666f6c486c696e6b3d22666f6c486c696e6b222f3e} Contact information for states maintaining records at the state level is provided on the State-Maintained Records listing. Department of Human Services Clarence H. Carter, Commissioner 505 Deaderick Street Nashville, TN 37243-1403 Contact Information. Your Authorization for Release of Information form and the fingerprint card must be complete . Crisis Line & Mobile Outreach Team If identifying information is missing (such as name ) your form will be returned . \par \tab \hich\af5\dbch\af31505\loch\f5 (1) "Aged" means an individual who is 60 years of age or older. 1-800-897-LINK(5465), You can find more information on background screenings in this, Abuse/Neglect of Seniors and Adults with Disabilities. \expnd0\expndtw-3\insrsid14438297 000000000000d60200007468656d652f7468656d652f7468656d65312e786d6c504b01022d00140006000800000021000dd1909fb60000001b01000027000000 (a) . The child care staff member needs to keep a copy of their letter for any future child care employers. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBIs Next Generation Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise responsible agency. \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Date;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text First Indent;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text First Indent 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Note Heading; Headquarters National Suicide Prevention Lifeline \par \tab \hich\af5\dbch\af31505\loch\f5 (a) a nursing care facility; Cannon Health Building \par \tab \hich\af5\dbch\af31505\loch\f5 (ii) passage of time; \par \tab \hich\af5\dbch\af31505\loch\f5 (c) an assisted living facility; or \par \tab \hich\af5\dbch\af31505\loch\f5 Background Screening Application - Youth Transport Company employeees only. Utah Department of Health and Human Services is now one agency. \tqr\tldot\tx9360\wrapdefault\hyphpar0\faauto\rin720\lin720\itap0 \rtlch\fcs1 \af5\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\loch\f5\hich\af5\dbch\af31505\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 toc 3;}{ e Department determines an individual is not eligible for direct patient access based upon the criminal background screening and the individual disagrees with the information provided by the Criminal Investigations and Technical Services Division or court \hich\af5\dbch\af31505\loch\f5 ety and health of patients or residents. \par \tab \hich\af5\dbch\af31505\loch\f5 (e) a personal care agency. The NICS conducts background checks on people who want to own a firearm or explosive, as required by law. This screening requires a separate application (see below). Utah Domestic Violence \par \tab \hich\af5\dbch\af31505\loch\f5 (c) does not include a student directly supervised by a member of the staff of the covered body or the student's instructor. 1-888-421-1100 In giving this authorization, I \par }{\rtlch\fcs1 \ab\af5 \ltrch\fcs0 \b\expnd0\expndtw-3\insrsid14438297 \hich\af5\dbch\af31505\loch\f5 R432-35-7. ;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 }{\listlevel\levelnfc3\levelnfcn3\leveljc0\leveljcn0\levelfollow2\levelstartat1\levelspace0\levelindent0{\leveltext \lsdpriority46 \lsdlocked0 List Table 1 Light Accent 6;\lsdpriority47 \lsdlocked0 List Table 2 Accent 6;\lsdpriority48 \lsdlocked0 List Table 3 Accent 6;\lsdpriority49 \lsdlocked0 List Table 4 Accent 6; If the email address is not legible or comes back invalid, it will be sent via USPS to the address listed for the non-licensed entity. voluntary, by what statutory or other authority your SSAN is solicited, and what uses will be made of it. \rtlch\fcs1 \af5 \ltrch\fcs0 \expnd0\expndtw-3\insrsid14438297 {\*\datafield 0c0070686f656e697800010000}}}{\fldrslt }}\sectd \ltrsect\pgnrestart\linex0\headery1440\footery1440\sectdefaultcl\sectrsid14438297\sftnbj {\rtlch\fcs1 \af5 \ltrch\fcs0 ffffffffffffffffffffffffffffffff52006f006f007400200045006e00740072007900000000000000000000000000000000000000000000000000000000000000000000000000000000000000000016000500ffffffffffffffffffffffff0c6ad98892f1d411a65f0040963251e5000000000000000000000000f073 \par \tab \hich\af5\dbch\af31505\loch\f5 (11) "Engage" means to obtain one's services: L. 92-544, Presidential Executive Orders, and federal. \par \tab \hich\af5\dbch\af31505\loch\f5 (C) 76-9-301.8, Bestiality; \par }}\ltrpar \sectd \ltrsect\pgnrestart\linex0\headery1440\footery1440\sectdefaultcl\sectrsid14438297\sftnbj {\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta . \par \tab \hich\af5\dbch\af31505\loch\f5 (a) engages a covered individual to provide services in a private residence to: (Salt Lake City, UT) The Centers for Disease Control and Prevention (CDC) issued recommendations for vaccinating children 5 years of age and younger against COVID-19. 5cd829496313fbb938871045de13265df05366ef10f50e7e40e941773f27d872f787b3c133c8b026a53240d4376beef0e57dccacf89d6ee8126157aae9f3c44a \par \tab \hich\af5\dbch\af31505\loch\f5 (ix) transportation staff; Prior Authorization - Utah Department of Health Medicaid This information will be used by the Department of Human Services, Office of Licensing to determine my eligibility to have direct access to a child or vulnerable adult. Employee Background Screening. However, information must be submitted for children who have turned 12 and any adults who have moved into the home. . GCHEXS will streamline applicant onboarding, background check processing, tracking and the notification . \par \tab \hich\af5\dbch\af31505\loch\f5 (b) As required by Utah Code Subsection 26-21-204, if an individual or covered individual has a warrant for arrest or an arrest for any of the identified offenses in R43\hich\af5\dbch\af31505\loch\f5 If HCJDC has questions, please contact: Staff Name: Requesting DHS . \lsdpriority73 \lsdlocked0 Colorful Grid Accent 1;\lsdpriority60 \lsdlocked0 Light Shading Accent 2;\lsdpriority61 \lsdlocked0 Light List Accent 2;\lsdpriority62 \lsdlocked0 Light Grid Accent 2;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 2; 0000000000005b436f6e74656e745f54797065735d2e786d6c504b01022d0014000600080000002100a5d6a7e7c0000000360100000b00000000000000000000 \lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text 3;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text Indent 2;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Body Text Indent 3; \par \tab \hich\af5\dbch\af31505\loch\f5 (v) an executive; This form must be completed and signed by the applicant. Call 801-977-6800 to set up your appointment. Headquarters DOC CONSENT FOR BACKGROUND CHECK AND - Hawaii These forms are only to be used by agencies who are authorized by statute, executive order, court rule, court order or local ordinance. \lsdpriority69 \lsdlocked0 Medium Grid 3 Accent 2;\lsdpriority70 \lsdlocked0 Dark List Accent 2;\lsdpriority71 \lsdlocked0 Colorful Shading Accent 2;\lsdpriority72 \lsdlocked0 Colorful List Accent 2;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 2; {\rtf1\adeflang1025\ansi\ansicpg1252\uc1\adeff5\deff0\stshfdbch31505\stshfloch31506\stshfhich31506\stshfbi31507\deflang1033\deflangfe1033\themelang1033\themelangfe0\themelangcs0{\fonttbl{\f0\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} 79fdf77c6eadca923b466964cafdf2dd1ffef3cd6fbd7ffff0ed2f5fff319b7a172f4cfcbbbffdeedd3ffef93ef5b0e2d2146ffff4fdbb1fbf7ffbe7dfffebaf \par \tab \hich\af5\dbch\af31505\loch\f5 (7) "Covered individual": \par \tab \hich\af5\dbch\af31505\loch\f5 (1) Convictions or Pending Charges One-time Adoption Background Screening Procedure: Background screenings are required for one-time adoptions. Georgia Criminal History Check System (GCHEXS) ere has been a failure to comply with the provisions of this chapter, or rules promulgated pursuant to this chapter, as follows: (2) The Department may allow a covered individual direct patient access with conditions, until the arrest or criminal charges are resolved, if the covered individual can demonstrate the work arrangement does not pose a threat to the saf \par \tab \hich\af5\dbch\af31505\loch\f5 (vi) administrative staff, including a manager or other administrator; PDF Office of Inspector General \par \tab \hich\af5\dbch\af31505\loch\f5 (a) means a hospital that is certified to provide long-term care services under the provisions of 42 U.S.C. Sexual Violence Crisis Line A check or money order made payable to the "Utah Department of Health" may be . If the applicant already has a RapBack subscription in DACS, the system will allow the screening agent to link to that application without paying new fees. \lsdpriority71 \lsdlocked0 Colorful Shading Accent 4;\lsdpriority72 \lsdlocked0 Colorful List Accent 4;\lsdpriority73 \lsdlocked0 Colorful Grid Accent 4;\lsdpriority60 \lsdlocked0 Light Shading Accent 5;\lsdpriority61 \lsdlocked0 Light List Accent 5; If there are criminal or abuse/neglect history items to disclose, you are asked to do so in either an uploaded document via your screening agent or if you choose not to share details with them, you may submit directly to OL at cbsunit@utah.gov, please be sure to place the DACS application number and your name and dob on your email or we will not know whose application to link the disclosure to. \lsdqformat1 \lsdpriority20 \lsdlocked0 Emphasis;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Document Map;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 Plain Text;\lsdsemihidden1 \lsdunhideused1 \lsdlocked0 E-mail Signature; 1-800-371-7897 \par \tab \hich\af5\dbch\af31505\loch\f5 (1) Utah Code, Title 26, Chapter 21, Part 2 requires that a covered employer be allowed to enter required information into the Direct Access Clearance System to initiate and obtain a cl\hich\af5\dbch\af31505\loch\f5 This form is for use by non-DHS licensed providers or adoption attorneys only, Complete a DCFS Livescan fingerprint scan and have the operator sign your Livescan Authorization form, Livescan locations and schedules may be accessed, Fingerprint cards may be submitted for applicants in rural areas who dont have access to Live Scan, There is no application fee for DCFS foster providers or adults living in the foster home. \par Code R432-35 - Background Screening - Health Facilities; Utah Admin. All U.S. employers must properly complete Form I-9 for each individual they hire for employment in the United States. This payment authorizes a subscription to the FBIs Rap Back System which continually monitors all fingerprint based criminal records in real time. 7afeb3d9a4d2f13d2151ba4094a5b8e76fb0f03fbbf7eb5fdd454732c609f6403e1547a8e7c752ae8eaa5531876124eeb0154ee1bb25e30992f0caa3ea82a34b How to Request a Background Check - University of Texas at Austin ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff \paperw12240\paperh15840\margl1440\margr1440\margt1440\margb1440\gutter0\ltrsect }}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}} \par }{\*\themedata 504b030414000600080000002100e9de0fbfff0000001c020000130000005b436f6e74656e745f54797065735d2e786d6cac91cb4ec3301045f748fc83e52d4a \par \tab \hich\af5\dbch\af31505\loch\f5 (b) a long-term care hospital; If the employee answers "Yes" to #2 or #3 of the form, court dockets or case reports are required to be submitted along with the application. If the background screening report reveals something that may cause you to decide not to hire the person, you must notify them of the results of the . Applicants also have the option to complete an online version of the Background Check Authorization form . }}{\*\pnseclvl3 Utah Administrative Code; Topic - Health; Title R432 - Family Health and Preparedness, Licensing; . Providing your fingerprints and associated information is voluntary; however, failure to do so may affect completion or approval of your application. c7060abb0884a4eff7a93dfeae8bf9e194e720169aaa06c3e2433fcb68e1763dbf7f82c985a4a725085b787086a37bdbb55fbc50d1a33ccd311ba548b6309512 \par \tab \hich\af5\dbch\af31505\loch\f5 (i) any felony or class A convi\hich\af5\dbch\af31505\loch\f5 ction under Utah Code. The Utah Bureau of Criminal Identification is responsible for all arrest and conviction data for the State of Utah. \lsdpriority60 \lsdlocked0 Light Shading Accent 3;\lsdpriority61 \lsdlocked0 Light List Accent 3;\lsdpriority62 \lsdlocked0 Light Grid Accent 3;\lsdpriority63 \lsdlocked0 Medium Shading 1 Accent 3;\lsdpriority64 \lsdlocked0 Medium Shading 2 Accent 3; used by Utah Department of Health (UDOH) to determine my eligibility for licensure as a medical cannabis product establishment owners or directors, or . with conditions, during an appeal process, if the covered individual can demonstrate the work arrangement does not pose a threat to the safety and health of patients or residents. \par \tab \hich\af5\dbch\af31505\loch\f5 (1) As required in Utah Code 26-21-204 the department may review relevant information obt\hich\af5\dbch\af31505\loch\f5 ained from the following sources: I understand that I may request to review any results of this inquiry and understand that UCA 53-10-108 does not allow the. \par \tab \hich\af5\dbch\af31505\loch\f5 (c) as a volunteer; or Option 2: Send a written challenge request to the FBI. \par (Written copy must be provided to all applicants submitting fingerprints for an FBI background check. Follow the instructions on page 2 of the form for submitting the form and the payment information. : 43003 Filed: 06/15/2018 10:31:45 AM. DACS | Division of Licensing and Background Checks - Utah 6e22206267313d226c743122207478313d22646b3122206267323d226c743222207478323d22646b322220616363656e74313d22616363656e74312220616363 When a person tries to buy a firearm, the seller, known as a Federal . (2) If the Department determines an individual is not eligible for direct patient access, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to t\hich\af5\dbch\af31505\loch\f5 Health, Administration. \lsdpriority50 \lsdlocked0 Grid Table 5 Dark;\lsdpriority51 \lsdlocked0 Grid Table 6 Colorful;\lsdpriority52 \lsdlocked0 Grid Table 7 Colorful;\lsdpriority46 \lsdlocked0 Grid Table 1 Light Accent 1;\lsdpriority47 \lsdlocked0 Grid Table 2 Accent 1; {\fhimajor\f31502\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0302020204030204}Calibri Light;}{\fbimajor\f31503\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;} d09bd06aa3566b55134452df4b51026a1f2f97648ebd9952e9dfdb2a1f53784da5500373caa74a35b6243476715e5708b11143cabd0b447b3eccb3609733fc52 \red255\green0\blue255;\red255\green0\blue0;\red255\green255\blue0;\red255\green255\blue255;\red0\green0\blue128;\red0\green128\blue128;\red0\green128\blue0;\red128\green0\blue128;\red128\green0\blue0;\red128\green128\blue0;\red128\green128\blue128;
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