Form Filler for DCF-3031

Please Read Before Continuing

As part of your employment process, you are required to complete an additional form. Please review the instructions and complete all fields.

The information you provide will directly pre-fill the CT DCF-3031 Form (Child Protective Services Background Check). The Department of Children & Families Background Checks Unit will search the Central Registry and Child Abuse & Neglect history. This is necessary for individuals who will be working with or providing services to children and families. Please note that processing the DCF form can take up to 5 business days after submission.

After completing the DCF form section, PLEASE RETURN TO THE ORIGINAL BACKGROUND REQUEST and finish the remaining portions of the background check requirements for the organization you are applying to. Thank you.
I, First Name* Last Name* do hereby authorize the Department of Children and Families to research its records and if applicable request out of state checks, to determine whether or not I am on the central registry of persons responsible for child abuse and neglect. I release the Department of Children and Families from any liability for any damages I may incur because of the release/use of this information.
Name of Employer/Organization (Requesting this search):*
Contact Name or Department of Employer/Organization:*
Address of Employer/Organization Requesting This Check:*

Address: (No. and Street)

Street Address Line 2

CityState

Zip
Your Full Legal First Name:*
Your Middle Name (If Applicable):
Your Full Legal Current Last Name:*
DOB:*

MonthDayYear
Date
Your Current Address:*

Address: (No. and Street)

Street Address Line 2

CityState

Zip
Start Date at Current Address:*

MonthDayYear
Date

List all previous applicant addresses for the last five years(If applicable), if you do enter information it must be completed all the way across, do not leave any blanks or N/A:

Rows	Address (No. and Street):	Apt.	City:	State:	Zip:	Dates From: (dd/mm/yyyy)	To (dd/mm/yyyy)

Other names I have used (Including preferred names, maiden, and previous marriages):

Rows	Last Name:	First Name:	Middle Name:

(If Applicable) Names of ALL children - biological/step (Including adult children in or out of the home)
Child 1:

First NameLast Name
DOB for Child 1:

MonthDayYear
Date
FemaleMaleOther
Child 2:

First NameLast Name
DOB for Child 2:

MonthDayYear
Date
FemaleMaleOther
Child 3:

First NameLast Name
DOB for Child 3:

MonthDayYear
Date
FemaleMaleOther
Applicant Signature:*
Signature Date:*

MonthDayYear
Date
Hour MinutesAM/PM Option
DCF Form 3031 Completed
Type option 1
Should be Empty:

(If Applicable) Names of ALL children - biological/step (Including adult children in or out of the home)