Washington State Department of Social and Health Services Home page

Forms

Background Authorization Form with Instructions: The Background Authorization Form is used to request a background check through BCCU.  The form is used by multiple DSHS programs to meet varying background check needs. The instructions provide general directions for completing the Background Check Authorization Form. The DSHS program that is requiring the background check may have additional instructions that you must follow.

For English: Word or PDF

For other languages:  Amharic, Arabic, Burmese, Cambodian, Chinese, Dinka, French, Farsi, Karen, Kayah, Kirundi, Korean, Laotian, Marshallese, NepaliNuerOromo, Polish, Punjabi, Russian, Samoan, Serbo-Croatian, SomaliSpanish, Spanish Word, SwahiliTagalog, Tigrigna, Trukese, Ukrainian, Vietnamese

Applicant Affidavit Form: The Affidavit Form is used by the applicant to provide details for:

  • Crimes reported by the Washington State Patrol (WSP), Washington Courts, Department of Corrections, the Federal Bureau of Investigation (FBI), or other states
  • Self-disclosures made on a Background Authorization Form   
  • Applicant disclosed in error to a question on the Background Authorization Form

NOTE: The Applicant Affidavit Form is NOT a substitute for the Background Authorization Form. It is only used to clarify or provide additional details regarding specific results for a completed background check. If you need a background check completed for an employee, please use the Background Authorization Form.

Please visit our FAQ page to find additional information related to Findings and Court Documents.

Applicant Request for Background Check Information Form: The applicant can use the Request for Background Check Form to request a copy of their background check results.

NOTE: This form is only to be used by the applicant. We will not mail or email results to a requesting entity using this form.