Adult Abuse/Neglect Central Registry Date Completed: Results: APPROVAL STATUS FORM REQUIRED: Yes No If Yes, DATE signed by Child and Family Services Administrator If Yes, DATE signed by Service Area Administrator HOME STUDY ADDENDUM REGISTER/Y, LAW ENFORCEMENT CHECKS AND CLEARANCE for Other Household Members Age 18 and Over Household Member Name: National Criminal History Check (Finger Prints) Date Completed: Results: Nebraska State Patrol Check Date Completed: Results: Nebraska Sex Offender Registry Date Completed: Results: Law Enforcement Check Date Completed: Results: Nebraska Child Abuse/Neglect Central Registry Date Completed: Results: Nebraska Adult Abuse/Neglect Central Registry Date Completed: Results: Google and Social Media Checks Date Completed: Results: Department of Motor Vehicle (DMV) Check Date Completed: Results: APPROVAL STATUS FORM REQUIRED: Yes No If Yes, DATE signed by Child and Family Services Administrator If Yes, DATE signed by Service Area Administrator Household Member Name: National Criminal History Check (Finger Prints) Date Completed: Results: Nebraska State Patrol Check Date Completed: Results: Nebraska Sex Offender Registry Date Completed: Results: Law Enforcement Check Date Completed: Results: Nebraska Abuse/Neglect Central Registry Date Completed: Results: Nebraska Adult Abuse/Neglect Central Registry Date Completed: Results:
Adult Abuse/Neglect Central Registry Results: Date Completed: APPROVAL STATUS FORM REQUIRED: Yes No If Yes, DATE signed by Child and Family Services Administrator If Yes, DATE signed by Service Area Administrator HOME STUDY ADDENDUM REGISTER/Y, LAW ENFORCEMENT CHECKS AND CLEARANCE for Other Household Members Age 18 and Over Household Member Name: National Criminal History Check (Finger Prints) Results: Date Completed: Nebraska State Patrol Check Results: Date Completed: Nebraska Sex Offender Registry Results: Date Completed: Law Enforcement Check Results: Date Completed: Nebraska Child Abuse/Neglect Central Registry Results: Date Completed: Nebraska Adult Abuse/Neglect Central Registry Results: Date Completed: Google and Social Media Checks Results: Date Completed: Department of Motor Vehicle (DMV) Check Results: Date Completed: APPROVAL STATUS FORM REQUIRED: Yes No If Yes, DATE signed by Child and Family Services Administrator If Yes, DATE signed by Service Area Administrator Household Member Name: National Criminal History Check (Finger Prints) Results: Date Completed: Nebraska State Patrol Check Results: Date Completed: Nebraska Sex Offender Registry Results: Date Completed: Law Enforcement Check Results: Date Completed: Nebraska Abuse/Neglect Central Registry Results: Date Completed: Nebraska Adult Abuse/Neglect Central Registry Results: Date Completed: