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 the $15.00 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

Employer Background Screening Request Form

Providers use this form to request background screening results on caregivers or potential caregivers at no charge. The individual to be screened must be registered with the FCSR before a background screening can be processed. Providers may submit an Employer Background Screening Request form along with the Worker Registration form(s) being submitted for caregivers new to the Registry. Both the provider and caregiver will receive written notification of the background screening results.

Providers who supply an email address are able to receive most background screening results via encrypted email. These providers will receive a separate email containing the automated results after each background screening request is processed.

• Employer Background Screening Request Form

Online Access for Providers

Some providers may find it more beneficial to create a secure, online account to submit background screening requests and manage the delivery of those results. This online access may be granted to a pre-approved provider in good standing with the Department of Health and Senior Services.

• How to Become an FCSR Online User.
• Memorandum of Agreement
• Online Background Screening Access/Security Request
  NOTE: This form is to request access to run screenings online. This form will not generate a background screening.
• First Time User Instructions and Frequently Asked Questions