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 $14.00 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.

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 request background screening results on employees or potential employees at no charge. The individual to be screened must be registered with the FCSR before a background screening can be processed. Employers may submit an Employer Background Screening Request 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 a signed copy of the Employer Background Screening Request form to 573-522-6981 or email a signed copy to fcsr@health.mo.gov.

When all fields have been completed, please print form, sign and date before submitting to the Family Care Safety Registry.

Online Access for Providers

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.

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. Click How to Become An FCSR Online User for more information.

When all fields have been completed, please print form, sign and date before submitting to the Family Care Safety Registry.