CAPECO

CAPECO

DHS Background Check Authorization - Volunteers
Due to our grant funding requirements, CAPECO is required to use the DHS background check system. The following form will gather information that will be used to enter into the Oregon Criminal History and Abuse Records Database System (ORCHARDS).

Once CAPECO enters the collected information into ORCHARDS an email will automatically be sent to you with instruction on how to complete the background check process. This email will come from bcu.orchards@odhsoha.oregon.gov. Please mark this email as a safe sender in your address book so that the information doesn't get sent to your junk mail.

You will be asked to upload a form of ID, so please have that ready prior to completing this form.

A copy of this information will be emailed to you once it is submitted.

Janell Scaplehorn

Human Resources

541-276-1926

jscaplehorn@capeco-works.org

All fields marked with an asterisk (*) are required.
Oregon Department of Human Services (DHS) Background Check
Please complete the required information below. You should expect to see an email with further instructions from bcu.orchards@odhsoha.oregon.gov within a week.
VolunteerPaid
Home Delivered MealsCongregate MealsStudent NurseOther
Select the senior meal location*
You can select more than one
Name*

First NameMiddle NameLast NameSuffix
YesNo
Provide other Names or Aliases used*
Date of Birth*

MonthDayYear
Date
FemaleMaleUnknown/Not SpecifiedOtherBoth
Permanent/Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Same as Permanent Address
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Provide any prior addresses, within the last five years, here. Include Year from: and Year to: for each.*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Social Security Number

The disclosure of your Social Security number (SSN) is optional. The Background Check Unit requests the SSN solely for the purpose of positively identifying you during the background check process. If you do not provide a SSN, the BCU may request fingerprints to confirm identity.

To provide SSN, read the entire terms and conditions, select the box, enter your SSN.
Social Security Number
(Per federal law, SSN is optional)
Identification Document

A copy of your photo identification is required to process your background check with the DHS. This document is used to confirm your identity against the information provided.

To provide one of approved forms of identification, read the entire terms and conditions, select the box, upload your document.
Upload one of the following:
- Oregon State Issued Driver's License
- Oregon State Issued Identification Card
- Non Oregon State Issued Driver's License
- Non Oregon State Issued Idenfication Card
- United States Armed Forces ID
- Passport
- Visa
- High School/College ID
- Other
- CC 7494 Listing
Upload front and back of document*

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Oregon Department of Human Services (DHS) Background Check