How to Submit a Request for:
'Search of Background Checks'
The Child Care Administration (CCA) would like to thank you for your commitment to serving Arizona’s families and children. Effective February 1, 2021, there are changes to the “Request for Search of Backgrounds Checks” process that we would like to share with you. ADES Contracted providers are now required to submit their Request for Search of Background Checks (CC-112A) through an online format by Cognito form.
The Cognito form application is available online through the following:
The Cognito form application is available online through the following:
How to Submit Arizona Central Registry Background Check Request
Online Application- Application Link – ( Request for Search of Background Check)
● Alias or maiden name (If Applicable)
● Social security number
If you do not have a Social Security Number, please complete an application (CC-112A) Request for Search of Background Checks Fillable Form (You must include a Passport for identification.) and scan all documents to ccacentralregistry@azdes.gov
- You must meet the following criteria
- This application contains a sworn statement and may only be completed by the owner of the individuals responsible for hiring staff and volunteers for this facility
- All individuals must have a Social Security Number to apply online
- The following Individual’s Personal Information is required:
● Alias or maiden name (If Applicable)
● Social security number
If you do not have a Social Security Number, please complete an application (CC-112A) Request for Search of Background Checks Fillable Form (You must include a Passport for identification.) and scan all documents to ccacentralregistry@azdes.gov
How to access the “Request for Search of Background Checks” paper fillable form CCA-1211A from our website?
(only if individual does not have a Social Security Number)
● Arizona Department of Economic Security website address: https://des.az.gov/documents-center?qt-content-tab=0
● The new document is “Request for Search of Background Checks” (effective 10/1/2017, Form number CCA-1211A) see image below for example
(only if individual does not have a Social Security Number)
● Arizona Department of Economic Security website address: https://des.az.gov/documents-center?qt-content-tab=0
● The new document is “Request for Search of Background Checks” (effective 10/1/2017, Form number CCA-1211A) see image below for example
The Following Individual’s Personal Information is required:
● Date of birth
● Sex
● Current address
● Out of state addresses within the last 5 years (If Applicable) (Please Read)
● Date of birth
● Sex
● Current address
● Out of state addresses within the last 5 years (If Applicable) (Please Read)
