Form CFS 718L Request for Updated Background Check for a Licensed Provider - Illinois

Form CFS718L or the "Request For Updated Background Check For A Licensed Provider" is a form issued by the Illinois Department of Children and Family Services.

The form was last revised in July 1, 2018 and is available for digital filing. Download an up-to-date Form CFS718L in PDF-format down below or look it up on the Illinois Department of Children and Family Services Forms website.

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CFS 718L
State of Illinois
Rev 07/2018
Department of Children and Family Services
REQUEST FOR UPDATED BACKGROUND CHECK FOR A LICENSED PROVIDER
TO:
Central Office of Licensing – if you are on OUTLOOK, please send to Permanency.Updates
if you do not have access to OUTLOOK, fax to 217-785-6368 or 217-782-6446
Updated Background Check Is Requested For License Provider #
for the purpose of:
Adoption
Subsidized Guardianship
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
ACKNOWLEDGMENT OF CONFIDENTIALITY OF LICENSE BACKGROUND CHECK INFORMATION
I understand that the background check information provided as a result of this request is strictly confidential and is
to be used only for the purpose specified above.
Name of Employee Requesting Check (please print):
Signature of Employee:
Agency/DCFS Team:
Address:
Telephone Number:
Fax Number:
Worker ID#:
Date:
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
RESULTS OF BACKGROUND CHECK BY THE CENTRAL OFFICE OF LICENSING:
FBL = Fingerprint-Based LEADS Check
NC =
Negative CANTS; no record of CANTS history
NF =
Negative Fingerprint Finding; no record of criminal history (fingerprint-based LEADS check).
PC =
Positive CANTS Finding.
PF =
Positive Fingerprint Finding; history rap sheet (fingerprint-based LEADS check) will be sent to the above address
within 24 hours.
Processed By:
Date:
CFS 718L
State of Illinois
Rev 07/2018
Department of Children and Family Services
REQUEST FOR UPDATED BACKGROUND CHECK FOR A LICENSED PROVIDER
TO:
Central Office of Licensing – if you are on OUTLOOK, please send to Permanency.Updates
if you do not have access to OUTLOOK, fax to 217-785-6368 or 217-782-6446
Updated Background Check Is Requested For License Provider #
for the purpose of:
Adoption
Subsidized Guardianship
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
Name:
Negative CANTS
Positive CANTS
SS#:
DOB:
Negative FBL
Positive FBL
ACKNOWLEDGMENT OF CONFIDENTIALITY OF LICENSE BACKGROUND CHECK INFORMATION
I understand that the background check information provided as a result of this request is strictly confidential and is
to be used only for the purpose specified above.
Name of Employee Requesting Check (please print):
Signature of Employee:
Agency/DCFS Team:
Address:
Telephone Number:
Fax Number:
Worker ID#:
Date:
----------------------------------------------------------------------------------------------------------------------------------------------------------------------
RESULTS OF BACKGROUND CHECK BY THE CENTRAL OFFICE OF LICENSING:
FBL = Fingerprint-Based LEADS Check
NC =
Negative CANTS; no record of CANTS history
NF =
Negative Fingerprint Finding; no record of criminal history (fingerprint-based LEADS check).
PC =
Positive CANTS Finding.
PF =
Positive Fingerprint Finding; history rap sheet (fingerprint-based LEADS check) will be sent to the above address
within 24 hours.
Processed By:
Date:
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