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Illinois Department of Children and Family Services Authorization For Background Check Child Abuse and Neglect Tracking System (CANTS)

The document is an authorization form for an individual to consent to a background check by the Illinois Department of Children and Family Services. It requests identifying information from the individual such as name, date of birth, addresses, and other names previously used. The individual signs to authorize the department to search its Child Abuse and Neglect Tracking System database to check if the person has been involved in any incidents of child abuse or neglect. The results will be released to the agency listed at the bottom of the form.

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ZeaEsther
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80 views

Illinois Department of Children and Family Services Authorization For Background Check Child Abuse and Neglect Tracking System (CANTS)

The document is an authorization form for an individual to consent to a background check by the Illinois Department of Children and Family Services. It requests identifying information from the individual such as name, date of birth, addresses, and other names previously used. The individual signs to authorize the department to search its Child Abuse and Neglect Tracking System database to check if the person has been involved in any incidents of child abuse or neglect. The results will be released to the agency listed at the bottom of the form.

Uploaded by

ZeaEsther
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Illinois Department of Children and Family Services

Authorization for Background Check


Child Abuse and Neglect Tracking System (CANTS)

Do Not use this form if you are an applicant for licensure or an


Employee/volunteer of a licensed child care facility.

Identifying Information (Type or Print Clearly)

Name: _____________________________________________________________________________________
Last First Middle

Date of Birth: __________________ Gender (circle): Male Female Race:_____________

Current Address: ____________________________________________________________________________


Street/Apt. #

____________________________________________________________________________
City State Zip Code

List all addresses at which you have resided in the past five years:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
List maiden name and/or all other names by which you have been known: (last, first, middle)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
I hereby authorize the Illinois Department of Children and Family Services to conduct a search of the
Child Abuse and Neglect Tracking System (CANTS) to determine whether I have been a perpetrator of
an incident of child abuse and/or neglect or involved in a pending investigation. I further consent to the
release of this information to the agency listed below.

Mail this request to:


_______________________________
Signed Date
Dept. of Children and Family Services
406 E. Monroe Station # 30
Springfield, IL 62701

St. Patrick Parish (Agency Parish Name)


Jon McCoy (Contact Person)
708 W. Main St. (Address)
Urbana, IL 61801 (City/State/Zip) 6/14

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