Application for a Background Check

Application Instructions

STOP: You must read the information below BEFORE applying.

To apply for a background check, you must complete the following steps:

  1. Application for a Background Check Packet - Complete, electronically sign, and submit the Application for a Background Check and the Authorization to Disclose a Background Check. Both documents must be signed and dated.

  2. MOVECHS Waiver Agreement-Printout a MOVECHS Waiver Agreement . Complete and sign with black or blue ink, then scan, and save it to your device. You cannot sign this document electronically. 

  3. Attach your MOVECHS Waiver Agreement at the end by clicking the Attach button after signing all documents. You must upload the MOVECHS Waiver Agreement and click Submit & Print in order to proceed.  You should get a thank you message and submission number. You will also have the chance to print or save the document you submitted here.

  4. After your documents have been reviewed by our team, you will receive a letter for fingerprinting. Follow the instructions in this letter to get your fingerprints completed. If you have not received this letter within 5 business days of submitting your documents, please email  cd.screen@dss.mo.gov.

IMPORTANT: Instructions for Youth Ages 18+ Living at a License-Exempt Facility

You are required by law to a complete a background check if you:

  • Are 18 years of age or older

  • Live at a licensed-exempt residential care facility or on the property

  • Are not an employee, volunteer, contractor, owner/operator

  • Have or may have unsupervised access to children who are in the care of the residential care facility

     

To apply for a background check, you must complete the following steps:

 

  1. Application for a Background Check Packet - Complete, electronically sign, and submit the Application for a Background Check and the Authorization to Disclose a Background Check. Both documents must be signed and dated. Make sure to check that you are a youth 18+ living at the facility. 

  2. You must click Submit & Print in order to proceed.  You should get a thank you message and submission number. You will also have the chance to print or save the document you submitted here.

  3. After we receive your application packet, we will send you the form “Request for Criminal Record Check.” This will check for convictions, arrests within 30 days, pending charges, suspended imposition of sentence (SIS) during probation, and will include a search of the state sex offender registry. The form must be completed, signed, and your payment of $14.00 for a name search included and mailed to:

               Missouri State Highway Patrol

               Criminal Justice Information Services Division                     

               PO Box 9500

               Jefferson City, MO 65102         

If you have questions or have not received an email from us within 5 business days of submitting your documents, please email cd.screen@dss.mo.gov .

PART I - AGENCY INFORMATION

PART II - IDENTIFYING INFORMATION

Specify the date of birth in ISO 8601 format.For example 1901-01-01
Specify the telephone number for the contact point.
Specify the telephone number for the contact point.

PART III - BACKGROUND INFORMATION

Have you ever been found guilty, pled guilty, or Nolo Contendere of any criminal act in any state as listed in Appendix A?

I hereby certify under oath subject to the penalties of perjury that all of the information I have submitted is true, accurate and complete to the best of my knowledge; I understand that a violation of §210.493 RSMo may constitute a criminal offense and knowingly making a materially false statement in connection with a background check shall render me ineligible. I request and authorize the Department of Social Services perform a background check as provided in Section 210.493 RSMo and 13. C.S.R. 35-71.015.

Department of Social Services

Authorization to Disclose Eligibility for Employment

 

Please indicate below if you give the Department of Social Services permission to share your eligibility results with the requesting agency.

Pursuant to 13 C.S.R. Section 35-71, I give permission to the Missouri Department of Social Services to send a copy of its eligibility decision upon completion of my background screening to the requesting agency notifying them of its decision on whether or not I am eligible or ineligible as provided by law.

I do not give permission to the Missouri Department of Social Services to send a copy of the findings of my background screening to the requested agency notifying them of its decisions on whether or not I am eligible or ineligible as provided by law.

I understand and agree that the Missouri Department of Social Services will not reveal any disqualifying offense or other related information regarding the applicant to the requesting agency. Section 210.493.9 RSMo.

The Department of Social Services will also send you a copy of the eligibility or ineligibility results. Please check which way you would like to get your results and provide that information:

    Appendix A

    Check “yes” and fill out the information in Part III of the Application for Background Screening for the question “Have you ever been found guilty, pled guilty, or nolo contender of any criminal act in this state or any state,” if you have pled guilty or nolo contendere to or been found guilty of:

    • Any felony for an offense against the person as defined in Chapter565 of the Revised Statutes of Missouri;

    • Any other offense against the person involving the endangerment of a child as prescribed by law

    • Any misdemeanor or felony for a sexual offense as defined in Chapter 566 of the Revised Statutes of Missouri;

    • Any misdemeanor or felony for an offense against the family as defined in Chapter 568 of the Revised Statutes of Missouri;

    • Burglary in the first degree as defined in section 569.160 of the Revised Statutes of Missouri;

    • Any misdemeanor or felony for robbery as defined in Chapter 570 of the Revised Statutes of Missouri;

    • Any misdemeanor or felony for pornography or related offense as defined in Chapter 573 of the Revised Statutes of Missouri;

    • Any felony for arson as defined in Chapter 569 of the Revised Statutes of Missouri;

    • Any felony for armed criminal action as defined in section 571.015 of the Revised Statutes of Missouri, unlawful use of a weapon as defined in section 571.030 of the Revised Statutes of Missouri, unlawful possession of a firearm as defined in section 571.070 of the Revised Statutes of Missouri, or the unlawful possession of an explosive as defined in section 571.072 of the Revised Statutes of Missouri;

    • Any felony for making a terrorist threat as defined in sections 574.115,574.120, or 574.125 of the Revised Statutes of Missouri

    • A felony drug-related offense committed during the preceding five years

    Any similar offense in any federal, state, or other court of similar jurisdiction of which you have knowledge.

    Thank You

    Dear {formsubmittinguser},

    Thank you for your submission to the Missouri Department of Social Services.

    If you have additional questions regarding background checks, please email CD.Screen@dss.mo.gov.

    If you have questions or want to check on the status of your submitted application packet, you may call the Children's Division Background Screening Unit at 573-526-1467. Your application number is {formuniqueid}.

    If you would like to print or save a copy of your application for your files, click the Print button below. If you decide to print or save, keep in mind that your application has your private and personal information in it.

    Sincerely,
    Children's Division Background Screening Unit