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 for an applicant in order to meet  to meet varying background check needs for DSHS programs. 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 clarify or provide additional details related to the following information being reported on a completed background check:

  • 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

IMPORTANT: The Applicant Affidavit Form is NOT a substitute for the Background Authorization Form. 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. This form is only to be used by the applicant. We will not mail or email results to a requesting entity using this form.

IMPORTANT: BCCU cannot discuss the results with the applicant over the phone until the applicant has a copy of their background results. Please have the background check results readily available when contacting BCCU.