WAIVER PROVIDER BACKGROUND SCREENING PROCESSING FORM

EMPLOYEE

You will need the information on this page when you go to have your livescan screening.

Live Scan vendors for your Level 2 finger printing may be found on the Department of Children and Families website at www.dcfbackgroundscreening.com or the Florida Department of Law Enforcement website at www.fdle.state.fl.us.

You must have the following information when you go to have your live scan.

•	The information on this page

•	Current Live Scan Background Screening Submission Form http://apdcares.org/background-screening/

•	Valid picture ID

•	Payment for the livescan screening

You may also need your:	• Address	• SS Number	• Birthdate	• Height	• Weight

Return this form (and/or any form provided to you by the livescan provider) and your receipt to Life's New Beginnings for filing in your employee file as proof you have completed your livescan screening.

You must also complete the Affidavit of Good Moral Character and the Local Law Request as part of your Level 2 background screening.

FULL NAME OF INDIVIDUAL BEING

LEVEL 2 BACKGROUND SCREENED
NAME OF AGENCY REQUESTING

BACKGROUND SCREENING

Life's New Beginnings, Inc.

AGENCY ADDRESS	7031 Rockwood Drive

Port Richey, Florida 34668

AGENCY'S TELEPHONE NUMBER

727-841-7161

AGENCY'S FAX NUMBER

727-841-7671

AGENCY'S EMAIL ADDRESS

amym22@verizon.net

DCF ORI NUMBER

EDCFGN10Z

DCF OCA NUMBER

23510571Z

REASON FINGERPRINTED	BACKGROUND CHECK RE: CHILDREN ETC.

CHAPTERS 39, 393, 394, 397, 402, 409, & 435 F.S.

NAME OF LIVE SCAN PROVIDER

DATE OF LIVE SCAN

LIVE SCAN VENDOR

Background Screening for the Department of Children and Families must include:

•	A valid ORI entered into the Controlling Agency Identifier field (this may also be the Requesting Agency field) on the Transaction Screen

•	The Provider Live Scan OCA number entered into the Originating Case Agency Field on the Miscellaneous Screen.