PLEASE READ PRIOR TO SUBMITTING THE ONLINE APPLICATION

Required Documents Needed:
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IF ANY STAFF THAT ARE LISTED AND IDENTIFIED  WITHIN THIS CCA REQUEST FOR
SEARCH OF BACKGROUND CHECKS (CCA-1211A) THAT THEY HAVE LIVED IN OTHER
STATES WITHIN THE LAST FIVE (5) YEARS, YOU ARE REQUIRED TO SUBMIT THE OUT
OF STATE CHECK FORM.

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.  Complete the forms and use the "Upload Documents" button within the Cognito Form (Click Here) to upload each out of state form for ALL employees that indicated "Yes" they have lived in other states in the last five (5) years.

Out of State Forms

States (A-G)
States (H-L)
States (M-N)
States (O-S)
States (T-W)

Please note:  We cannot process your CCA 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:

CCA Central Registry - P.O. Box 6123 MD54F2, 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