Form DCF-3033 "Authorization for Release of Information for Foster Care or Adoption Dcf Cps Search" - Connecticut

What Is Form DCF-3033?

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-3033 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

ADVERTISEMENT
ADVERTISEMENT

Download Form DCF-3033 "Authorization for Release of Information for Foster Care or Adoption Dcf Cps Search" - Connecticut

1205 times
Rate (4.5 / 5) 84 votes
Department of Children and Families
AUTHORIZATION FOR RELEASE OF INFORMATION FOR FOSTER CARE or ADOPTION DCF CPS SEARCH
DCF-3033
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 for any and all information
Date Processed:
concerning charges, findings, including substantiated and unsubstantiated reports and protocols, dispositions,
etc. relating to child abuse or neglect in which I / my family have been named, and to release it to the agency
Central Registry:
YES
NO
listed below. I understand that this information will be used solely to determine my suitability for: Foster Care
Processor’s Initials:
or Adoption by:
Agency Name:
History Found:
YES
NO
See Attached if History Found
Agency 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 is DCF Employee
Applicant Last Name:
Applicant First Name:
Middle:
DOB:
SS:
City:
State:
Zip:
Applicant Address (No. and Street):
Apartment #:
Years at current address?:
Years
Months
Previous Address(es)/List All for the Last Five Years
Check if an additional sheet is necessary and attached
Dates From:
Dates To:
Address (No. and Street):
City:
State:
Zip:
Apartment #:
(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
Received a Careline Check within
Last Name
First Name:
Middle:
DOB:
the past 2 years? (CPA must verify)
Yes
No
Yes
No
Yes
No
Yes
No
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
Select One or Enter your own
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
How To Submit: Email:
DCF.BackgroundCheck@ct.gov
| Fax: 860-560-7071 | Mail: DCF-Background Check Unit, 505 Hudson Street, Hartford, CT 06106
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.
Applicant Signature:
Date:
Child Placing Agency Signature:
Date:
Department of Children and Families
AUTHORIZATION FOR RELEASE OF INFORMATION FOR FOSTER CARE or ADOPTION DCF CPS SEARCH
DCF-3033
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 for any and all information
Date Processed:
concerning charges, findings, including substantiated and unsubstantiated reports and protocols, dispositions,
etc. relating to child abuse or neglect in which I / my family have been named, and to release it to the agency
Central Registry:
YES
NO
listed below. I understand that this information will be used solely to determine my suitability for: Foster Care
Processor’s Initials:
or Adoption by:
Agency Name:
History Found:
YES
NO
See Attached if History Found
Agency 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 is DCF Employee
Applicant Last Name:
Applicant First Name:
Middle:
DOB:
SS:
City:
State:
Zip:
Applicant Address (No. and Street):
Apartment #:
Years at current address?:
Years
Months
Previous Address(es)/List All for the Last Five Years
Check if an additional sheet is necessary and attached
Dates From:
Dates To:
Address (No. and Street):
City:
State:
Zip:
Apartment #:
(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
Received a Careline Check within
Last Name
First Name:
Middle:
DOB:
the past 2 years? (CPA must verify)
Yes
No
Yes
No
Yes
No
Yes
No
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
Select One or Enter your own
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
How To Submit: Email:
DCF.BackgroundCheck@ct.gov
| Fax: 860-560-7071 | Mail: DCF-Background Check Unit, 505 Hudson Street, Hartford, CT 06106
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.
Applicant Signature:
Date:
Child Placing Agency Signature:
Date: