PLEASE READ PRIOR TO SUBMITTING THE CCA-1211A FORM
Required Documents Needed:
ANY STAFF THAT HAVE LIVED OUT OF ARIZONA IN THE PAST 5 YEARS ARE REQUIRED
TO COMPLETE AND SUBMIT A REQUEST FOR SEARCH OF BACKGROUND CHECKS (CCA-1211A)
AND ANY APPLICABLE OUT OF STATE FORM.
FOLLOW THE LINKS BELOW TO FIND THE FORMS ASSOCIATED WITH OTHER STATES.
ANY STAFF THAT HAVE LIVED OUT OF ARIZONA IN THE PAST 5 YEARS ARE REQUIRED
TO COMPLETE AND SUBMIT A REQUEST FOR SEARCH OF BACKGROUND CHECKS (CCA-1211A)
AND ANY APPLICABLE OUT OF STATE FORM.
FOLLOW THE LINKS BELOW TO FIND THE FORMS ASSOCIATED WITH OTHER STATES.
INSTRUCTIONS: Please click the link below to access the forms you are required to submit on all staff that have indicated that they have lived in other states within the last five (5) years.
Out of State Forms
Please note: We cannot process your DCC Request for Search of Background Check until we have ALL required documents when it has been identified that a staff member has lived in another state(s) in the past five (5) years. Incomplete or late submission of the request may result in a delay in processing this Request for Search of Background Checks. A letter will be emailed to the provider to correct and resubmit the form within 14 business days.
The following States require a processing fee - Please download the form and submit all
required documents along with a Money Order to the following address:
DCC Central Registry - P.O. Box 6123 MD85B1, Phoenix, AZ 85005
States that REQUIRE a processing fee as follows:
Arkansas, Colorado, Idaho, Kansas, Kentucky, Louisiana, Minnesota, Nebraska,
Pennsylvania, Rhode Island, South Carolina, Virginia, Washington, and Wyoming
required documents along with a Money Order to the following address:
DCC Central Registry - P.O. Box 6123 MD85B1, Phoenix, AZ 85005
States that REQUIRE a processing fee as follows:
Arkansas, Colorado, Idaho, Kansas, Kentucky, Louisiana, Minnesota, Nebraska,
Pennsylvania, Rhode Island, South Carolina, Virginia, Washington, and Wyoming
