Worker Registration Form

A person may register online by clicking Register Online or by mailing a completed Worker Registration Form, photocopy of their Social Security card and the $13.00 registration fee (if applicable) by check or money order, made payable to Missouri Department of Health and Senior Services. Registrants will receive written notification of their background screening results.

  • Worker Registration Form
  • Worker Registration Form -This form is in Microsoft Word format. Select 'Read-only' to open form. When all fields have been completed, please print form, sign and date before submitting to the Family Care Safety Registry.

Employer Background Screening Request Form

Employers use this form to obtain background screening results on employees or potential employees at no charge. Before a background screening can be run on an individual, the individual must be registered with the FCSR. Employers may submit an Employer Background Screening form along with the Worker Registration form(s) being submitted for employees new to the Registry. Both the employer and employee will receive written notification of the background screening results.

An employer may FAX this form to 573-522-6981 or email a signed copy of this form to fcsr@health.mo.gov.

Internet Access for Providers

Providers are able to receive most background screening results via encrypted email. Providers who have supplied an email address receive a separate email after each background screening request (with automated results) is processed.

Some providers may find it easier to create a secure, online account to submit background screening requests and manage delivery of background screening results. Internet access for obtaining background screening results may be granted to a pre-approved provider in good standing with the Department of Health and Senior Services. Click How to Become A FCSR Internet User for more information.