224-277-1645
Get Hired
Book Appointment

Background Check

Home / Background Check

State of Illinois
Department of Children and Family Services

AUTHORIZATION FOR BACKGROUND CHECK

Child Abuse and Neglect Tracking System (CANTS)

For Programs NOT Licensed by DCFS

NOTE: Do not use this form if you are an applicant for licensure or an employee/volunteer of a licensed child care facility. Please contact your licensing representative.

Name :
Date of Birth:
Gender:
Race:
Current Address:
City :
State :
Zip :
If you currently reside in Illinois, please list all previous addresses for the past five years.
OR
If you currently reside out-of-state, please provide ALL Illinois addresses in which you did reside while living in Illinois
(Street/Apt#/City/County/State/Zip Code)
Dates : From/To
List maiden name and/or all other names by which you have been known: (last, first, middle)
I hereby authorize the Illinois Department of Children and Family Services to conduct a search of the Child Abuse and Neglect Tracking system (CANTS) to determine whether I have been a perpetrator of an indicated incident of child abuse and/or neglect or involved in a pending investigation. I further consent to the release of this information to the agency listed below.
Clear Sign Signed
Date
Submit by mail OR fax OR email.

Mail to: Department of Children and Family Services 406 E. Monroe – Station # 30 Springfield, IL 62701

FAX to: 217-782-3991
Scan/Email to: CFS689Background@illinois.gov

Please type, use bold letters or label:
(Submitting Agency Fax Number)
(Submitting Email Address)
(Agency Name)
(Contact Person)
(Contact Person)
(City/State/Zip)
Download PDF