Form DCF-3031 "Authorization for Release of Information for Dcf Cps Search" - Connecticut

What Is Form DCF-3031?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-3031 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-3031 "Authorization for Release of Information for Dcf Cps Search" - Connecticut

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Connecticut Department of Children and Families
AUTHORIZATION FOR RELEASE OF INFORMATION FOR DCF CPS SEARCH
DCF-3031
10/18 (Rev.)
Page 1 of 1
(This area for DCF Use only)
I,
(Applicant Name):
do hereby authorize the Department of Children and Families to research its records to determine
Date Processed:
whether or not I am on the me central registry of persons responsible for child abuse and neglect
Central Registry:
YES
NO
I understand that this information may be used to determine my suitability solely for (check one):
Employment
Day Care
Volunteer
Intern
Mentor
Processor’s Initials:
Other:
Name of Agency (requesting background check):
Attention:
Address: (No. and Street):
City:
State:
Zip:
I release the Department of Children and Families from any liability for any damages I may incur which may result from the release / use of this information.
I submit my following information to assist the Department of Children and Families in their search.
Applicant Last Name
Applicant First Name:
Middle:
DOB:
SS:
Applicant Address: (No. and Street):
Apartment #:
City:
State:
Zip:
Years at current address?”
Years
Months
List All Previous Applicant Address(es) for the Last Five Years
Check if an additional sheet is necessary, and attached
Dates From:
Dates To:
Address: (No. and Street):
Apartment #:
City:
State:
Zip:
Month
Year
Month
Year
Other Names I have Used – Including Maiden, Previous Marriages(s)
Check if an additional sheet is necessary and attached
Last Name
First Name:
Middle:
DOB:
SS:
Name of Spouses/Other Adults in the Home – Past and Present
Check if an additional sheet is necessary and attached
Last Name
First Name:
Middle:
DOB:
Signature (if still in the home)
Date:
Names of ALL Child(ren) – Biological, Stepchildren, Including Adult Children In or Out of the Home
Check if an additional sheet is necessary and attached
Last Name
First Name:
Middle:
DOB:
Gender:
Select One or Enter your own
Select One or Enter your own
Select One or Enter your own
Select One or Enter your own
Yes
No
Yes
No
Do you have an active DCF investigation at this time?
Do you have an active appeal of a DCF investigation at this time?
Applicant Signature:
Date:
This authorization will expire 180 days after the date of the signature. Forms not filled out completely and / or clearly will be returned. Do not leave any blank spaces. Please specify
with “N/A” if not applicable. **DCF Conducts a Search of the CT Registry ONLY** The Accuracy of this Search is Limited to the Information Provided by the Applicant to DCF.
DCF.BackgroundCheck@ct.gov
| Fax: 860-560-7071 | Mail: DCF-Background Check Unit, 505 Hudson Street, Hartford, CT 06106
How To Submit: Email:
Please be advised that due to the large volume of forms received, we are unable to provide confirmation of receipt or status updates during the background
check process. If, after 4 weeks, you do not receive the results of any form(s) you sent in or if you have any questions, please contact the BGC Unit.
 
 
Connecticut Department of Children and Families
AUTHORIZATION FOR RELEASE OF INFORMATION FOR DCF CPS SEARCH
DCF-3031
10/18 (Rev.)
Page 1 of 1
(This area for DCF Use only)
I,
(Applicant Name):
do hereby authorize the Department of Children and Families to research its records to determine
Date Processed:
whether or not I am on the me central registry of persons responsible for child abuse and neglect
Central Registry:
YES
NO
I understand that this information may be used to determine my suitability solely for (check one):
Employment
Day Care
Volunteer
Intern
Mentor
Processor’s Initials:
Other:
Name of Agency (requesting background check):
Attention:
Address: (No. and Street):
City:
State:
Zip:
I release the Department of Children and Families from any liability for any damages I may incur which may result from the release / use of this information.
I submit my following information to assist the Department of Children and Families in their search.
Applicant Last Name
Applicant First Name:
Middle:
DOB:
SS:
Applicant Address: (No. and Street):
Apartment #:
City:
State:
Zip:
Years at current address?”
Years
Months
List All Previous Applicant Address(es) for the Last Five Years
Check if an additional sheet is necessary, and attached
Dates From:
Dates To:
Address: (No. and Street):
Apartment #:
City:
State:
Zip:
Month
Year
Month
Year
Other Names I have Used – Including Maiden, Previous Marriages(s)
Check if an additional sheet is necessary and attached
Last Name
First Name:
Middle:
DOB:
SS:
Name of Spouses/Other Adults in the Home – Past and Present
Check if an additional sheet is necessary and attached
Last Name
First Name:
Middle:
DOB:
Signature (if still in the home)
Date:
Names of ALL Child(ren) – Biological, Stepchildren, Including Adult Children In or Out of the Home
Check if an additional sheet is necessary and attached
Last Name
First Name:
Middle:
DOB:
Gender:
Select One or Enter your own
Select One or Enter your own
Select One or Enter your own
Select One or Enter your own
Yes
No
Yes
No
Do you have an active DCF investigation at this time?
Do you have an active appeal of a DCF investigation at this time?
Applicant Signature:
Date:
This authorization will expire 180 days after the date of the signature. Forms not filled out completely and / or clearly will be returned. Do not leave any blank spaces. Please specify
with “N/A” if not applicable. **DCF Conducts a Search of the CT Registry ONLY** The Accuracy of this Search is Limited to the Information Provided by the Applicant to DCF.
DCF.BackgroundCheck@ct.gov
| Fax: 860-560-7071 | Mail: DCF-Background Check Unit, 505 Hudson Street, Hartford, CT 06106
How To Submit: Email:
Please be advised that due to the large volume of forms received, we are unable to provide confirmation of receipt or status updates during the background
check process. If, after 4 weeks, you do not receive the results of any form(s) you sent in or if you have any questions, please contact the BGC Unit.