Application for DSS 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 with the CURRENT date.

  2. MOVECHS Waiver Agreement - Click here to Download the 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 will receive a thank you message and confirmation 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 an email from us with further instructions. Follow these instructions and continue to check your email for correspondence from our unit. Regularly check your inbox and spam folders for the email address you listed on your application. If you have not received an email from us within 5 business days of submitting your documents, please email CD.Screen@dss.mo.gov. Upon receipt of an approved application, we will send you an email with instructions to get fingerprinted and register with FCSR. DO NOT submit fingerprints until you have been authorized by DSS.

IMPORTANT: Instructions for Residents 18 or older 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 and reside on campus

  • 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 with the CURRENT date. Make sure to check that you are 18 or older living at the facility. 

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

  3. After your documents have been reviewed by our team, you will receive an email from us with further instructions.  Follow those instructions and continue to look for further correspondence from our unit by email. Please check the inbox and spam folders of the email address you listed on the application. If the application packet is approved , 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 $15.00 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

Checking eligibility status only----By selecting this option, you are reporting to DSS that you are not currently affiliated with a facility or agency. Please note that should you decide to pursue employment or presence in the future, you will be required to submit a new Application for DSS Background Check and have an eligibility determination made prior to beginning employment or presence at the agency or facility. 

PART II - IDENTIFYING INFORMATION

FULL LEGAL NAME (Last, First, MI, Jr., Sr., III)

Specify the date of birth in ISO 8601 format.For example 1901-01-01

CURRENT PHYSICAL ADDRESS (STREET, CITY, STATE, ZIP)

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 indicated below if you give DSS permission to share eligibility results with the facility or agency in which you are applying.

Pursuant to 13 C.S.R. Section 35-71, I give permission to DSS to send a copy of its eligibility decision upon completion of my background screening to the facility or agency referenced on my application notifying them of its decision on whether I am eligible or ineligible as provided by law.

 

I do not give permission to DSS to send a copy of its eligibility decision to the facility or agency referenced on my application notifying them of its decisions on whether I am eligible or ineligible as provided by law.

 

Checking eligibility status only----By selecting this option, you are reporting to DSS that you are not currently affiliated with a facility or agency. Please note that should you decide to pursue employment or presence in the future, you will be required to submit a new Application for DSS Background Check and have an eligibility determination made prior to beginning employment or presence at the agency or facility.

 

I understand and agree that DSS will not reveal any disqualifying offense or other related information regarding the applicant to the agency referenced on my application. 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 DSS Background Check for the question “Have you ever been found guilty, pled guilty, or nolo contenderer 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 Chapter 565 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