Background Check Authorization Form

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Online Background Check Authorization Form for Applicants

  1. Please click on the following link to open the online Background Check Authorization form (If you are having issues with the form, please try completing the form in Google Chrome.)
  2. There are help tools incorporated into the form. Click on the ? icons.  BCS Online Authorization Form Guide
  3. After signing and saving your Background Check Authorization form, the system will generate a confirmation code, which is a saved version of your authorization form.  Please email, save, or write down the confirmation code so that you don't lose it.  You will NOT be able to retrieve your confirmation code after closing/exiting the web page and BCCU does not have the ability to retrieve them for you.
  4. Provide your confirmation code and date of birth to the entity requesting your background check. The requesting entity might be a care facility (like an AFH, nursing home, etc), IP contracting office, Consumer Direct (CDWA), a potential employer, your case manager, your current employer, or something similar. You can provide your confirmation code and your date of birth to multiple requesting entities. Confirmation codes are only valid for 90 days from the date of submission. 


Background Check Authorization Form with Instructions (DSHS 09-653)

The Background Check Authorization Form is completed by the applicant and given to the requesting entity.  Applicants also have the option to complete an online version of the Background Check Authorization form. The requesting entity will submit your background check through the online Background Check System (BCS).  The DSHS program that is requiring the background check may have additional instructions that you must follow. 

Consumer Direct Care Network Washington (CDWA) Guide

Consumer Direct Care Network Washington (CDWA) is the Consumer Directed Employer (CDE) for DSHS and employs Individual Providers who provide in-home personal care.  Our CDWA Individual Provider/Caregiver Background Check Guide covers the background check process for CDWA Individual Providers.

Please note that the Background Check Central Unit (BCCU) is NOT part of Consumer Direct Care Network Washington (CDWA), so we cannot assist with anything within the DirectMyCare Portal; including (but not limited to) logging hours, payments, updating background check expiration dates, etc.