Forms

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 a $11.00 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 ran 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 on 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.

Employer Background Screening Request Form

Employer Background Screening Request 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.

 

Internet Access for Providers

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.

Memorandum of Agreement

Internet Background Screening Access/Security Request

First-Time Users Instructions