Background Checks

All DSHS Certifications/Authorizations expire after four years unless renewal requirements are met. To satisfy the background check requirement you must:

  • Print Background Check Attestation Form

  • Check the boxes that apply to you

  • Sign, date and list DSHS credential number(s) in the spaces provided

  • Take a picture or scan the document

  • Email to

  • Once LTC has acknowledged receipt of your background check attestation form, that requirement for renewal will be satisfied