Department of Date: The Department has reviewed the criminal, child Justice Cleared NOT Cleared welfare and DMV history for this applicant and makes the following determination: Child Abuse Date: Index Cleared NOT Cleared Approved FBI Records Date: Check Cleared NOT Cleared Not Approved DMV Records Date: Check Cleared NOT Cleared CWS Records Date: Check Cleared NOT Cleared OTHER ADULTS IN THE HOME Name: Department of Justice: The Department has reviewed the Cleared Not Cleared criminal, CWS and DMV history for this adult and makes the Child Abuse Index: following determination: Cleared Not Cleared FBI Records Check: Approved Cleared Not Cleared Not Approved DMV Records Check: Cleared Not Cleared CWS Records Check: Cleared Not Cleared Name: Department of Justice: The Department has reviewed the Cleared Not Cleared criminal, CWS and DMV history for this adult and makes the Child Abuse Index: following determination: Cleared Not Cleared FBI Records Check: Approved Cleared Not Cleared Not Approved DMV Records Check: Cleared Not Cleared CWS Records Check: Cleared Not Cleared REFERENCES - See DSS CWS 151 attached Date Person(s) Interviewed Location
Department of Justice Date: Cleared NOT Cleared The Department has reviewed the criminal, child welfare and DMV history for this applicant and makes the following determination: Approved Not Approved Child Abuse Index Date: Cleared NOT Cleared FBI Records Check Date: Cleared NOT Cleared DMV Records Check Date: Cleared NOT Cleared CWS Records Check Date: Cleared NOT Cleared OTHER ADULTS IN THE HOME Name: Department of Justice: Cleared Not Cleared Child Abuse Index: Cleared Not Cleared FBI Records Check: Cleared Not Cleared DMV Records Check: Cleared Not Cleared CWS Records Check: Cleared Not Cleared The Department has reviewed the criminal, CWS and DMV history for this adult and makes the following determination: Approved Not Approved Name: Department of Justice: Cleared Not Cleared Child Abuse Index: Cleared Not Cleared FBI Records Check: Cleared Not Cleared DMV Records Check: Cleared Not Cleared CWS Records Check: Cleared Not Cleared The Department has reviewed the criminal, CWS and DMV history for this adult and makes the following determination: Approved Not Approved REFERENCES - See DSS CWS 151 attached Date Person(s) Interviewed Location
dss_cws_153-b_rfa_dss_assessment_report.docx