Employee and Contractor
Background Check Process (Webcast, help)
A caregiver is a person who meets all of the following:
- is employed by or under contract with an entity;
- has regular, direct contact with the entity’s clients or the
personal property of the clients; and
- is under the entity’s control.
This includes employees who provide direct care and may also include
housekeeping, maintenance, dietary and administrative staff, if those
persons are under the entity’s control and have regular, direct contact
with clients served by the entity.
As the license holder/legal representative, you must do the following:
Have the employee or contractor complete
Information Disclosure (BID) form, F82064 (PDF,
30 KB). Keep this completed BID on file.
Department of Justice, Division of Law Enforcement Services
(exit DHS) - select Requesting a Record Check, obtain and complete a Wisconsin
Criminal History Record Request (Single Subject Requests DJ-LE-250
or Multiple Subject Requests DJ-LE-250A), marking
"Caregiver-General" under Request Purpose.
- Submit the DJ-LE-250 or DJ-LE-250A with appropriate fee, payable to
"Department of Justice" and a self-addressed stamped
Crime Information Bureau
Attn: Record Check Unit
P.O. Box 2688
Madison, WI 53701-2688
If you have an account with DOJ, you may request this information on
the Criminal History Record Check
website (exit DHS).
NOTE: Please do not submit forms for your employees to DQA.
For more detailed information, see
Chapter 2 of the Wisconsin Caregiver Program Manual (PDF, 24 KB)
A complete caregiver background check always consists of the
A completed F82064 Background Information Disclosure (BID) form:
A response from the Department of Justice (DOJ)
Wisconsin Criminal History Record Request, either a "no record
found" response or a criminal record transcript (Wisconsin
Identification Data). The following forms are available from the
Wisconsin Department of
Justice (exit DHS).
Wisconsin Criminal History Single Name Record Request Form
Wisconsin Criminal History Multiple Name Record Request Form
Wisconsin Criminal History Account Application Form DJ-LE-251
- A "Response to Caregiver Background Check" letter from the
Department of Health Services (DHS) that reports the
person’s administrative finding or licensing restriction status.
These three items are to be retained with the employee's records
and to be made available when requested by DQA staff for survey purposes.
Other documentation must be obtained by the
entity when information is needed to complete the background check, such
as other state’s conviction records, military discharge papers, arrest
and conviction disposition information from local clerks of courts or
tribal courts, etc.
June 24, 2014