The CYFD Background Check form is a crucial document required for individuals seeking employment in licensed childcare facilities in New Mexico. This form facilitates the necessary criminal history record checks mandated by state and federal laws to ensure the safety and well-being of children. Understanding the process and requirements of the background check can help applicants navigate this essential step in their childcare career.
The CYFD Background Check form is a crucial step for individuals seeking employment in licensed childcare facilities and homes in New Mexico. This form is designed to ensure the safety and well-being of children by conducting thorough background checks on potential employees. Applicants must provide specific information, including their fingerprints, which must be taken using designated fingerprint cards. These cards serve as legal documents and must be completed with accuracy, as any errors can lead to delays in processing. The form requires applicants to submit a social security number, which is essential for identifying them within criminal databases. Moreover, the Children, Youth and Families Department (CYFD) emphasizes the confidentiality of the information gathered during the background check process. Applicants should prepare to submit a checklist of required documents, including written statements from employers and a fee for processing. Understanding these components is vital for a smooth application process and to ensure compliance with state and federal laws.
When filling out the CYFD Background Check form, attention to detail is crucial. Here’s a helpful list of what you should and shouldn’t do to ensure a smooth application process.
By following these guidelines, you can help ensure that your background check process goes as smoothly as possible. Take your time, and don’t hesitate to reach out for assistance if needed.
Understanding the CYFD Background Check form can be challenging. Here are some common misconceptions that people often have:
In reality, the background check is mandatory for anyone working in licensed childcare facilities. State and federal laws require it to ensure the safety of children.
Only the applicant can fill out the fingerprint cards, and they must remain unaltered. Any changes made to these legal documents can lead to rejection of the application.
While providing your SSN is voluntary, the CYFD cannot process your background check without it. This number is essential for identifying you in various databases.
Only one money order is accepted per applicant. Combining multiple payments will result in the application being returned without processing.
Fingerprinting must be done using the specific cards included in the application packet. Additionally, it is advisable to contact local law enforcement agencies for proper procedures.
Even if your mailing address is the same, it is important to include it in your application to avoid any confusion regarding where correspondence will be sent.
The results of the background check are sent to the licensed center or childcare home where you are applying. You will not receive the results directly.
Can a Certified Check Be Cancelled - Make sure to submit it as soon as possible after the loss.
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Licensed
Background Check
and
Fingerprint Instructions
IF YOU HAVE QUESTIONS ABOUT YOUR BACKGROUND CHECK, CONTACT:
Background Check Unit
Phone: (505) 827-7326
Fax: (505) 827-7422
Address: P.O. Drawer 5160
Santa Fe, NM 87502-5160
Si usted necesita ayuda a completar este paquete, por favor llame (505) 827-7326
CYFD Background Check Unit
07/30/2010
LICENSED CHILDCARE HOMES AND FACILITIES
State and Federal laws prohibit the disclosure of information reviewed as a result of a background check and require security of records containing this information.
Completed fingerprint cards and accompanying information are legal documents. All documents submitted to the Children, Youth and Families Department become the property of the Department. The fingerprint cards and forms cannot be altered by anyone other than the applicant, and must clearly state the reason fingerprinted as “Employment in a Licensed Facility” or “Employment in a Licensed Childcare Home.”
The licensed center or home will receive a letter from the background check unit that indicates whether the applicant is eligible to provide childcare.
Privacy Act Statement
Children, Youth and Families Department’s (CYFD) request for your social security number (SSN) is made under the New Mexico Children’s and Juvenile Facility Criminal Records Screening Act, Section 32A-15-1 to 32A-15-4 NMSA 1978, as amended, which requires criminal history record checks be conducted on all staff and employees of child care facilities or programs that have primary custody of children for twenty hours or more a week. CYFD will use your SSN in the course of your background investigation to identify you within criminal databases and within its Protective Services Division files. Compliance with the SSN request is voluntary. However, be advised that CYFD cannot process a background check without it.
PLEASE SUBMIT ALL REQUIRED FORMS AND FEES TO:
CHILDREN, YOUTH AND FAMILIES DEPARTMENT
ATTN: AS / BACKGROUND CHECK UNIT
P.O. DRAWER 5160
SANTA FE, NM 87502-5160
CHECKLIST
Have you included all of the following?
2 Fingerprint Cards
Applicant Written Statement
Employer Statement (to be filled out by employer if applying to work in a facility)
Dispositions (if applicable)
Money Order or Cashier’s Check
O$33.00 payable to CYFD
We will only accept one money order per applicant. Please do not combine money orders. Any money order received in the amount over $33.00 will be accepted; however, the excess amount is non- refundable.
Incomplete or illegible applications, or applications that are missing any of the required information or fees will be returned without further processing.
This is your physical address. Please include your mailing address in your application.
Employment in a Licensed Facility OR
Employment in a Licensed Childcare Home
32A-15-3 NMSA 1978
NM920120Z
Child Care Lic Bu
Santa Fe, NM
FINGERPRINT CARD INSTRUCTIONS
1.Get Fingerprinted. Prints may be taken by some law enforcement agencies, including your local police department, sheriff’s office, or state police office. We encourage you to contact your local law enforcement agency to make arrangements for obtaining fingerprints. Use only the fingerprint cards included in this packet. Have at least one form of picture ID with you when you get fingerprinted. PLEASE NOTE: There may be a fingerprinting fee.
2.Complete the Top Portion of the Fingerprint Card IN BLACK INK. A sample fingerprint card is attached.
3.The fingerprint card must be typewritten or legibly printed. Illegible fingerprint cards will be rejected.
4.You must have two fingerprint cards.
REQUIRED INFORMATION:
LAST NAME: Complete last name. No abbreviations.
FIRST NAME: Complete first name. No abbreviations or nicknames.
MIDDLE NAME: Complete middle name. No initials, abbreviations, or nicknames. If you do not have a middle name, put “NMN.”
SIGNATURE OF PERSON FINGERPRINTED: Sign in the presence of the person who rolls your fingerprints.
RESIDENCE OF PERSON FINGERPRINTED: This is the physical address of the applicant. Please make sure to include your mailing address in another document, if different than the physical address. ALIASES USED BY THE APPLICANT: Include maiden name(s), nickname(s), previous married names, or any other name you have used.
CITIZENSHIP OF APPLICANT: Please identify your
citizenship by country. For example: United States, Mexico, Germany, Argentina, etc.
DATE OF FINGERPRINTING: The date the fingerprints are taken.
SIGNATURE OF OFFICIAL TAKING FINGERPRINTS: The person who rolls the fingerprints will sign this. EMPLOYER AND ADDRESS: This is the name and address of the employer, and this is the address the clearance/denial letters will be mailed to. Make sure it is the correct mailing address.
SOCIAL SECURITY NO: This is the social security number of the applicant.
SEX: Male or Female
RACE: Enter the race. See the sample fingerprint card for codes.
HEIGHT: Use whole inches only.
WEIGHT: Use whole pounds only.
EYE: See sample fingerprint card for codes.
HAIR: See sample fingerprint card for codes.
DATE OF BIRTH: Enter the date of birth of the applicant. Include month, day and year.
PLACE OF BIRTH: Enter the city and state, or, if outside the United States, enter the country.
REASON FINGERPRINTED:
Enter “Employment in a Licensed Facility” or “Employment in a Licensed Childcare Home.”
ENTER THE FOLLOWING INFORMATION ONLY IF IT APPLIES TO YOU:
ARMED FORCES NO: If you have an armed forces number, enter it here. Otherwise, if you served in the military, enter the branch here.
FBI NO: Enter your FBI number, if you have one.
MISCELLANEOUS NO: If you have another identifying number (i.e. Alien Registration Number), enter it here.
DO NOT ENTER INFORMATION IN THE FOLLOWING FIELDS:
ORI
OCA
ANY OTHER FIELD MARKED “LEAVE BLANK”
APPLICANT WRITTEN STATEMENT
INSTRUCTIONS: Use additional sheets as necessary. All questions must be answered completely and to the best of your knowledge. If you are applying for “Employment in a Licensed Childcare Home,” all adult household members (age 18 and over) must fill out their own Applicant Written Statement and provide fingerprint card and the required fee. Please print legibly. Answers left blank, or a response of “N/A” may result in the rejection of the application.
Full Name (include birth name, married name(s), nick names, and aliases. Do not use initials).
Date of Birth (month, day, year)
Place of Birth (city, state, country)
Social Security Number
Primary Language
______/ ______ / __________
___________________, ______/_______
_______ - _____ - __________
_________________________
Current Physical Address
_______________________________
Address
Address (optional)
_______________, _______________
City
State
Zip
Mailing Address (if different from physical)
Contact Information
Primary Phone Number
Secondary Phone Number (optional)
E-Mail Address
Previous Address/Addresses (past ten years, most recent first, and include number, street, city, state, zip code.)
If you need more space, use a separate sheet of paper.
Current Spouse/Significant Other
________________________________________________
_____
__ - _____ - __________
First
Middle
Last
Date of Birth(month, day, year)
Full Name(s) and Date(s) of Birth of: Birth Children, Adopted Children, Foster Children, and other Children who have lived in your household(s) within the past ten years (If you need more space, use a separate sheet of paper)
First Name
Middle Name
Last Name
/
Current Marital Status (circle one): Single
Married
Separated
Divorced
Widowed
Full Name(s) and Date(s) of Birth of all Adults who have previously lived with you (within the past ten years) (If you need more space, use a separate sheet of paper)
Full Name(s) and Date(s) of Birth of all Adults who are currently living with you (If you need more space, use a separate sheet of paper)
Names and Places of School(s) attended, along with graduation dates (High School, University, College, and Vocational Training) (If you need more space, use a separate sheet of paper)
Name of School
Location of School
Graduation Date
Type (high school, college, etc.)
Employment History (list all dates and places of employment from age 18 to date - explain breaks in employment) (If you need more space, use a separate sheet of paper)
Employer
Start Date
End Date
Explain Break in Employment
IF YOU DO NOT UNDERSTAND THESE QUESTIONS, PLEASE SEEK GUIDANCE BEFORE ANSWERING THEM!
Have you ever been involved in a CYFD investigation of abuse or neglect of children or adults as the alleged perpetrator or household member? If so, provide the dates of all such investigations and the outcome of those investigations. NOTE: Failure to provide this information may lead to denial of your application.
_____ Yes, I have been involved in a CYFD (or other protective service agency) investigation of abuse or neglect of children or adults as the alleged
perpetrator or household member (Provide details).
_____ No, I have never been involved in a CYFD (or other protective service agency) investigation of abuse or neglect of children or adults as the alleged
perpetrator or household member.
Have you ever been charged with, arrested for, or convicted of a crime? NOTE: Failure to provide this information may lead to denial of your application.
_____ Yes, I have been charged with, arrested for, or convicted of a crime (Provide an explanation and disposition).
_____ No, I have never been charged with, arrested for, or convicted of a crime.
Under penalty of perjury, I ____________________
__________ certify the above statements to be true and complete to the best
of my knowledge.
SIGNATURE: ________________________
___
_______
DATE: _____________
CYFD. Background Check Unit. Applicant Written Statement. 07/30/2010. Page 2
EMPLOYER STATEMENT
I, ____________________________, authorized representative of _______________________, hereby
(NAME OF HR REP OR DIRECTOR)(NAME OF FACILITY)
attest that __________________________, is an applicant for employment, an employee, contractor or
(NAME OF APPLICANT)
volunteer with _____________________. This applicant, employee, contractor or volunteer requires a
(NAME OF FACILITY)
CYFD background check pursuant to 8.8.3 NMAC and has direct care responsibilities or potential unsupervised access to care recipients.
I understand that by signing this statement, ____________________________ waives any claim that
this applicant, employee, contractor or volunteer does not have direct care responsibilities or does not have potential unsupervised access to care recipients in the event that he/she is determined to be an unreasonable risk and denied background check eligibility.
____________________________________
NAME OF EMPLOYER REPRESENTATIVE
TITLE
PHONE NUMBER
DATE
Disposition Request Information Sheet
CYFD is requesting disposition because some types of convictions can result in denial of a background check clearance. Disposition means outcome. CYFD wants to know the final outcome of the arrest.
Where to find disposition
Disposition can often be found at the courts in the county where you were arrested. You can also contact the agency that arrested you, or contact the attorney who represented you, if you had one.
Phone numbers for the Courts, Police Departments, and Attorneys can generally be found in the phone book, in the Government and/or Yellow pages. Out of state information might be found on the internet.
Acceptable forms of disposition
Dispositional information can be found in documents called:
Judgment and Sentence
Plea and Disposition Agreement
Nolle Prosequi
Certificate of Conviction
If you are unsure which of the forms contains your disposition, ask the Court clerk for help.
We will not accept
Clerk’s Certificates marked “No Felony Convictions”
Documentation from the arresting agency marked “No Record Found”
An explanation of the arrest from your attorney.
Please call our office at (505) 827-7326 if you have any questions.
Disposition must be received no later than 15 days after the date of the request. It is your responsibility to provide this information to CYFD. This sheet is for informational purposes only. Your search for disposition should not be limited to the ideas presented here.
Rehabilitation Petition Information Sheet
What is a rehabilitation petition?
A rehabilitation petition is an opportunity for the applicant to submit information regarding a criminal or protective services history that might otherwise result in a determination of unreasonable risk.
Why am I being asked to submit this information?
AS Background Check Unit has determined that an arrest or referral in your past might indicate that you are an unreasonable risk.
How do I submit a rehabilitation petition?
If you are required to submit a rehabilitation petition, AS Background Check Unit will mail you a request.
What should I include in a rehabilitation petition?
1.A statement telling AS Background Check Unit what steps you have taken to assure that the event(s) we inquire about will not happen again.
2.Do include:
a.A specific description of what actions you have taken subsequent to any events revealed by the background check to reduce the risk that the same or a similar circumstance will re-occur.
b.Specific examples that prove rehabilitation by clear and convincing evidence
3.Do not include:
a.Court documents, certificates, character references, or other collateral information UNLESS it is used to prove your statements
b.Court documents, certificates, character references, or other collateral information instead of a statement
What if I have questions?
If you have questions regarding the rehabilitation petition, contact the AS Background Check Unit at 505-827-7326
How will I know if you accept the petition?
Please allow AS Background Check Unit at least 7 working days to review the information you submit; you will receive a response in the mail.
What if I do not want to do the petition?
Failure to return the petition to us within fifteen days of the mail date of the letter, will result in denial of the application, in accordance with 8.8.3.10(C) NMAC, which states: “If there is a need for any further information from an applicant at any stage of the process, the department shall request the information in writing from the applicant. If the department does not receive the requested information within fifteen calendar days of the date of the request the department shall deny the application.”
What if I need more than 15 days to do the petition?
You must contact the AS Background Check Unit, in writing, to secure an extension. Requests for extension can be mailed, faxed, or mailed electronically to:
FAX: 505-827-7422
ADDRESS: CYFD / AS / BCU
PO DRAWER 5160
SANTA
FE
NM
87502-5160