This form is required for reporting new applicants, new hires, and employment changes for congregate care workers to ensure compliance with state and federal background check requirements. Pursuant to s. 48.685(2), Wis. Stats., and the Family First Prevention Services Act (FFPSA), all adults who work in a congregate care facility, including caregivers as defined under s. 48.685(1)(ag)1., must complete checks pertaining to criminal history, caregiver misconduct, professional credentials, child abuse and neglect, and licensure history. Additionally, all congregate care workers must complete an FBI fingerprint background check.
New applicant, new employee, and existing employee includes contractors and paid interns.
List all applicable facilities for applicant/employee
(ex: maiden, married, hyphenated, etc.)
The New Applicant section is intended for potential hires only. If the individual is currently/newly employed by the provider, please refer to the 'New Employee' or 'Existing Employee' section.
Upload a PDF of the BID, DOJ/IBIS, and if applicable, the out-of-state check, DD214 (Certificate of Release or Discharge from Active Duty issued by the U.S. Department of Defense), or DCF rehab review.
Submit checks for current employee whose previous checks have expired or will be expiring soon.
Resubmit checks previously submitted with inaccurate or missing information.
If No, submit another form for the employment ended notification for the currently assigned facility
Upload any outstanding documents for the employee
