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In the state of Louisiana, a critical step in upholding the safety and welfare of children within licensed childcare and juvenile detention facilities hinges upon the thorough and accurate completion of the State Central Registry Disclosure Form. Mandated by the Department of Children and Family Services, this requirement applies to individuals including owners, operators, administrators, and those seeking employment or volunteer opportunities in these sensitive environments. Specifically, this legal document serves as a preventative measure against enabling individuals with a history of child abuse or neglect to work closely with this vulnerable demographic. Should an individual be found guilty of falsifying information on this form, they face misdemeanor charges, underscoring the gravity of ensuring honest disclosures. Furthermore, this form not only seeks to capture current identification details but also historic data potentially relevant to the applicant’s suitability for their role. Rigorously maintained by facility owners or operators, adherence to the disclosure form's stipulations reflects a broader commitment to child safety as enshrined in Louisiana statutes R.S. 46:1414.1.C and R.S. 15:1110.2(C). The mechanics of this process, including the detailed information requested, underscore the vital role due diligence plays in child protection within the state’s legislated framework for licensed facilities.

Form Example

SCR-1 LIC

Rev. 01/13

06/11 Issue Obsolete

STATE OF LOUISIANA

DEPARTMENT OF CHILDREN AND FAMILY SERVICES STATE CENTRAL REGISTRY DISCLOSURE FORM

This form must be completed by each individual owner, operator, administrator, current or prospective employee or volunteer of a child care facility or juvenile detention facility licensed by the Louisiana Department of Children and Family Services for themselves. Any owner, operator, administrator, current or prospective employee, or volunteer of a child care facility or juvenile detention facility licensed by the department who knowingly falsifies the information on the State Central Registry Disclosure Form shall be guilty of a misdemeanor offense and shall be fined not more than five hundred dollars, or imprisoned for not more than six months, or both. R.S. 46:1414.1.C or R.S. 15:1110.2(C).

This form shall be maintained by the owner/operator of the licensed facility in accordance with current licensing standards as mandated by R.S. 46:1414.1.B or R.S. 15:1110.2(B).

Name of Licensed Facility (Print or Type)

Physical Address of Licensed Facility

 

 

 

 

 

 

 

 

 

 

 

License #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Individual/Applicant (Print or Type)

 

 

 

 

 

Date of Birth

 

 

 

Social Security #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Maiden, Previous or Any Other Name Used

 

 

 

 

 

Race

 

 

 

Sex

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Street Address

 

 

 

 

 

 

 

City and State

 

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Most Recent Previous Address

 

 

 

 

 

 

City and State

 

 

 

 

 

Zip Code

(

)

-

 

 

 

(

)

-

 

 

 

 

 

 

(

)

-

 

 

Current Home Phone #

 

 

 

Current Cell Phone #

Work Phone #

 

 

 

 

My name

is

is not

currently recorded as a perpetrator on the State Central Registry for what the

 

 

(check one)

Department of Children and Family Services (DCFS) has determined to be a justified

 

 

 

 

(valid) finding of child abuse or neglect.

 

 

 

 

 

 

I

have

have not

been determined to have a justified (valid) finding of abuse or neglect since the Risk

 

 

 

 

Evaluation Panel finding.

 

 

 

 

 

 

 

 

 

 

 

 

 

If the DCFS Licensing Section has reasonable suspicion or is provided with facts or information that your name is on the State Central Registry as a perpetrator with a valid/justified finding of abuse and/or neglect, the Licensing Section may request a clearance of the SCR without your permission. If your name does in fact appear on the SCR as described above, the department will notify both your employer (the facility named above) and the appropriate District Attorney’s office of your failure to comply with R.S. 46:1414.1 or R.S. 15:1110.2.

The information given is true and complete to the best of my knowledge.

Signature

 

Date

 

 

 

Signature of Licensed Facility Representative

 

Date

Document Breakdown

Fact Detail
Purpose of the Form Used by individuals associated with child care or juvenile detention facilities licensed by the Louisiana Department of Children and Family Services to disclose their criminal history related to child abuse or neglect.
Who Must Complete It Owners, operators, administrators, current or prospective employees, and volunteers of child care or juvenile detention facilities licensed by the department.
Penalty for Falsification Knowingly falsifying the form results in a misdemeanor offense, including a fine up to five hundred dollars, imprisonment for up to six months, or both.
Governing Laws R.S. 46:1414.1.C or R.S. 15:1110.2(C) for penalties; R.S. 46:1414.1.B or R.S. 15:1110.2(B) for maintenance standards.
Maintenance of the Form The form is maintained by the facility's owner/operator in accordance with current licensing standards.
Content Requirements Includes personal identification details, declaration about the status on the State Central Registry as a perpetrator of child abuse or neglect, and contact information.
Procedure for SCR Clearance If there's reasonable suspicion or evidence of a person's name on the SCR as a perpetrator, the Licensing Section may seek a clearance without the person's permission. Failure to disclose being on the SCR may lead to notification of the employer and the appropriate District Attorney's office.

Instructions on Filling in Louisiana Central Registry

Filling out the Louisiana Central Registry Disclosure Form is a critical step for individuals associated with child care and juvenile detention facilities in Louisiana. This form plays a key role in ensuring the safety and well-being of children by verifying that those in sensitive positions do not have a history of justified findings of abuse or neglect. As this document is a legal requirement, providing accurate and complete information is crucial. Here's how to complete the form step by step.

  1. Start by entering the Name of the Licensed Facility where you are an owner, operator, administrator, current or prospective employee, or volunteer.
  2. Fill in the Physical Address of the Licensed Facility, including the License # associated with the facility.
  3. Write your Name as the Individual/Applicant clearly in the designated space. Make sure to print or type for legibility.
  4. Provide your Date of Birth and Social Security # in the respective fields to confirm your identity.
  5. Include any Maiden, Previous or Any Other Name Used to ensure a comprehensive background check.
  6. Select your Race and Sex from the options given, which is necessary for identification purposes.
  7. Enter your Current Street Address, including City and State, followed by the Zip Code.
  8. Provide details of your Most Recent Previous Address, including the City and State and Zip Code, to complete the background information required.
  9. List your contact information: Current Home Phone #, Current Cell Phone #, and Work Phone #.
  10. Check the appropriate box to indicate whether your name is or is not currently recorded as a perpetrator on the State Central Registry for a justified finding of child abuse or neglect.
  11. If you have been determined to have a justified finding of abuse or neglect since the last Risk Evaluation Panel finding, mark the appropriate box to declare this status.
  12. Read the declaration about the accuracy of the information you provided and the implications of falsifying information.
  13. Sign and date the form in the provided spaces to certify that the information given is true and complete to the best of your knowledge.
  14. Have a representative of the Licensed Facility sign and date the form as well, confirming their acknowledgment of your submission.

After completing the form, remember that it should be maintained by the owner/operator of the licensed facility in line with current licensing standards. This ensures that the document is accessible for verification by the Department of Children and Family Services if needed. Providing honest and accurate information on the form is not only a legal obligation but also a crucial step to protect the well-being of children in care and detention facilities.

Listed Questions and Answers

What is the Louisiana Central Registry Disclosure Form?

This form is a mandatory document required by the State of Louisiana for individuals engaged in child care or juvenile detention facilities. It collects personal information and details about the applicant's history related to child abuse or neglect. The purpose is to ensure the safety and well-being of children under the care of these facilities.

Who needs to complete the Louisiana Central Registry Disclosure Form?

Every owner, operator, administrator, current or prospective employee, or volunteer at a child care or juvenile detention facility licensed by the Louisiana Department of Children and Family Services must fill out this form personally.

What are the consequences of falsifying information on this form?

Falsifying information on the State Central Registry Disclosure Form is considered a misdemeanor offense. Individuals may be fined up to five hundred dollars, imprisoned for not more than six months, or both.

How is the form maintained and why?

The owner or operator of the licensed facility is responsible for the maintenance of this form. It must be kept in accordance with current licensing standards, as this ensures compliance with state regulations and helps protect children in these facilities.

What information is required on the form?

The form requires detailed personal information, including:

  • Name of the licensed facility
  • Physical address of the facility
  • License number
  • Individual's name, date of birth, and social security number
  • Any other names used
  • Race and sex
  • Contact information
  • Current and most recent previous addresses
  • Disclosure about the individual's history concerning child abuse or neglect

What happens if someone is found to have falsified this form?

Beyond the criminal penalties, if an individual is discovered to have falsified their form, their employer and the appropriate District Attorney's office will be notified of the non-compliance. This could lead to further legal actions and possibly affect the person's employment.

Can the DCFS Licensing Section check the Central Registry without permission?

Yes, if the DCFS Licensing Section has a reasonable suspicion or facts informing them that an individual's name might be on the Central Registry as a perpetrator with a justified finding of abuse and/or neglect, they can request a clearance without the individual's permission.

What is a justified finding of abuse or neglect?

A justified finding of abuse or neglect refers to a determination by the Department of Children and Family Services that there is sufficient evidence to confirm an incident of child abuse or neglect by an individual.

If an individual has a justified finding of abuse or neglect, can they work in a licensed facility?

If an individual's name appears on the State Central Registry as a perpetrator with a validated finding of abuse or neglect, the DCFS is required to notify the employer and potentially take actions that could prevent the individual from working at the licensed facility.

What is the ultimate goal of the Louisiana Central Registry Disclosure Form?

The primary objective is to safeguard the welfare and safety of children in child care and juvenile detention facilities by ensuring that individuals with a history of child abuse or neglect are identified and appropriately managed.

Common mistakes

Filling out the Louisiana Central Registry Disclosure Form accurately is crucial for individuals associated with child care or juvenile detention facilities. Unfortunately, mistakes can occur. Awareness of common errors helps prevent issues that could arise from incorrect or incomplete submissions. Here are eight mistakes often made:

  1. Not providing complete information for all required fields, such as failing to include a maiden name or any previous names used. This omission can lead to incomplete checks or confusion regarding identity.
  2. Incorrectly stating the name of the licensed facility. This mistake can lead to processing delays or misinterpretation of the application.
  3. Forgetting to list the most recent previous address, which is critical for a thorough background check and ensuring the accuracy of registry searches.
  4. Providing inaccurate contact information, including phone numbers, which can hinder communication about the status of the form or follow-up requests.
  5. Failure to disclose a current or previous finding of being a perpetrator of child abuse or neglect. This dishonesty not only breaches legal requirements but also jeopardizes the safety of children under care.
  6. Not checking the appropriate boxes that accurately reflect the individual's status on the State Central Registry. Misrepresentation, whether intentional or accidental, can have serious legal repercussions.
  7. Omitting the signature and date at the end of the form. This oversight can invalidate the submission, as these elements are necessary for verification and processing.
  8. Allowing typos or unclear handwriting to compromise the readability of the form. Errors of this nature can lead to incorrect data entry or additional queries, slowing down the process.

It's essential that individuals take the time to review their form for accuracy and completeness before submission. Attention to detail can prevent the common mistakes listed above and ensure a smoother processing experience.

Documents used along the form

When individuals in Louisiana engage with the State Central Registry Disclosure Form for child care or juvenile detention facilities, they often find themselves navigating a landscape filled with various other forms and documents. The process ensures that those involved in the care and supervision of children meet the highest standards of safety and responsibility. Highlighted below are five additional forms and documents commonly used alongside the Louisiana Central Registry Disclosure Form, each playing a pivotal role in the comprehensive evaluation and documentation process.

  • Authorization for Release of Information: This form is typically used to grant permission for the Louisiana Department of Children and Family Services (DCFS) to perform a background check. It includes consenting to a review of criminal records, past employment, and any other checks deemed necessary by the department.
  • Child Abuse/Neglect Background Clearance Form: Distinct from the Central Registry Disclosure, this form seeks information related to any past allegations of child abuse or neglect. It specifically asks whether the individual has been involved in any reported incidents, aiming to protect children from potential harm.
  • Employee Health Certification: To ensure the health and safety of both workers and children, this form certifies that an individual does not have any communicable diseases or health conditions that could endanger the welfare of children in their care. It may require a signed statement from a healthcare provider.
  • Emergency Contact and Personal Information Form: While basic in nature, this essential document collects current contact information, including addresses, phone numbers, and emergency contacts, ensuring that facility operators can quickly respond in case of an emergency or need for immediate communication.
  • Child Care Staff Employment Eligibility Verification: Often involving the I-9 form, this document verifies an employee's legal right to work in the United States. Completing this form is a federal requirement for all employees, including those in child care settings, to prevent unlawful employment.

Together, these documents form a comprehensive framework to reinforce the safety, integrity, and professionalism of individuals working in environments with vulnerable populations. By meticulously completing and maintaining these records, child care and juvenile detention facilities in Louisiana take crucial steps toward safeguarding the well-being of children under their care.

Similar forms

The Louisiana Central Registry form is similar to other official documents required in sectors focusing on the welfare and safety of children and vulnerable individuals. These include the Child Abuse and Neglect Background Check forms used in various states and the Volunteer Disclosure Statement required by organizations that work with minors or vulnerable adults. This form, like its counterparts, aims to screen individuals to ensure the safety of those under their care or influence.

Child Abuse and Neglect Background Check forms also serve a protective purpose, much like the Louisiana Central Registry form. Such forms are mandated by state laws across the United States to prevent individuals with a history of child abuse or neglect from working with children. They require the disclosure of personal information, including past criminal history related to child abuse or neglect. The similarity lies in their comprehensive nature, aimed at vetting the background of individuals who wish to work in environments that cater to children's welfare. Both forms are crucial barriers against potential harm to children and serve as a vetting mechanism by state agencies or licensed facilities.

The Volunteer Disclosure Statement is another document that echoes the aims and requirements of the Louisiana Central Registry form. Organizations that engage volunteers to work with children, the elderly, or other vulnerable populations often use these statements. They require volunteers to disclose any past criminal convictions that would disqualify them from participation. Like the Louisiana Central Registry form, the Volunteer Disclosure Statement is a tool for organizations to protect those under their care by ensuring that volunteers have no history of harmful behavior. Both forms act as self-reporting tools that complement official background checks, emphasizing the individual's responsibility to disclose relevant information for the safety of vulnerable populations.

Dos and Don'ts

When filling out the Louisiana Central Registry (SCR) Disclosure Form, it's essential to approach the task with care and accuracy, given the form's importance in the context of employment within child care and juvenile detention facilities. Here are several do's and don'ts to guide individuals through the process efficiently and lawfully.

Do:
  • Provide accurate information: Ensure all personal details and answers regarding your history with the State Central Registry are truthful and complete.
  • Review the information before submission: Double-check all the entries for accuracy and completeness to avoid any errors or omissions that could lead to legal issues.
  • Understand the legal implications: Be aware that knowingly falsifying information on this form is a misdemeanor offense, subject to fines, imprisonment, or both.
  • Report any changes: If your status with the State Central Registry changes after submitting the form, notify the relevant authorities and the licensed facility immediately.
  • Keep a copy for your records: After completing the form, retain a copy for your personal records to maintain a history of disclosed information.
Don't:
  • Falsify information: Never attempt to withhold or distort information related to your history with child abuse or neglect, as it's a criminal offense.
  • Ignore the form's instructions: Adhere closely to the guidelines provided in the form to ensure that every section is filled out correctly and completely.

By adhering to these guidelines, individuals can accurately complete the Louisiana Central Registry Disclosure Form, thus fulfilling their legal obligations and contributing to the safety and well-being of children in care facilities.

Misconceptions

When discussing the Louisiana Central Registry Disclosure Form, there are several misconceptions that can confuse individuals and facilities. It's essential to clarify these misunderstandings to ensure compliance and protect the welfare of children and families involved.

  • Misconception 1: The form is optional for those working in child care or juvenile detention facilities. In reality, every owner, operator, administrator, employee, or volunteer must complete it as mandated by the Louisiana Department of Children and Family Services.
  • Misconception 2: Only individuals with prior convictions need to worry about the form. The truth is, this form must be completed regardless of one's criminal history, as it specifically relates to abuse or neglect findings by the Department of Children and Family Services.
  • Misconception 3: Falsifying information on this form has minimal consequences. Falsifying information is a misdemeanor offense that can lead to fines up to five hundred dollars or imprisonment for up to six months, or both.
  • Misconception 4: The information provided on the form is shared publicly. The form's information is maintained confidentially by the facility's owner/operator in accordance with licensing standards.
  • Misconception 5: This process is a one-time requirement. It's important to understand that any new or additional findings of abuse or neglect must also be disclosed, not just those at the time of initial application or employment.
  • Misconception 6: The form only concerns Louisiana residents. Anyone working or volunteering in a licensed facility within Louisiana, regardless of their state of residence, must complete the form.
  • Misconception 7: If your name is on the State Central Registry as a perpetrator, you are automatically disqualified from working with children. While a valid finding on the registry raises serious concerns, there is a process for review and the form itself offers a chance to declare such findings.
  • Misconception 8: The facility operator does not need to verify the information provided. The Department of Children and Family Services may request a clearance of the State Central Registry without permission if there's reasonable suspicion or evidence provided regarding an individual's status as a perpetrator.
  • Misconception 9: All sections of the form apply to every individual. Some questions or sections may not apply depending on the individual's history and circumstances; however, completing the form accurately and truthfully is imperative.
  • Misconception 10: The form is the only step in ensuring a safe environment for children. While important, this form is part of a broader set of checks and balances designed to protect children, including background checks and ongoing training and assessment.

Understanding these key points about the Louisiana Central Registry Disclosure Form is crucial for all individuals and facilities involved in the care and supervision of children within the state. It ensures not only regulatory compliance but also the safety and well-being of children in these environments.

Key takeaways

Filling out and using the Louisiana Central Registry (SCR) Disclosure Form is a crucial step for those involved with child care and juvenile detention facilities. Understanding the key takeaways can help ensure that the process is completed accurately and effectively. Here are six important points to remember:

  • Specific Audience: The SCR Disclosure Form must be completed by individuals such as owners, operators, administrators, current or prospective employees, or volunteers at child care facilities or juvenile detention facilities that are licensed by the Louisiana Department of Children and Family Services.
  • Legal Implications: Knowingly falsifying information on the SCR Disclosure Form is a misdemeanor offense. Offenders can face a fine of up to five hundred dollars, imprisonment for up to six months, or both, as per R.S. 46:1414.1.C or R.S. 15:1110.2(C).
  • Maintenance of the Form: The owner or operator of the licensed facility is responsible for maintaining the SCR Disclosure Form according to current licensing standards mandated by Louisiana law (R.S. 46:1414.1.B or R.S. 15:1110.2(B)).
  • Honest Disclosure: Applicants must honestly disclose whether their name is currently recorded as a perpetrator on the State Central Registry for a justified (valid) finding of child abuse or neglect.
  • Procedure Upon Suspicion: If the DCFS Licensing Section suspects or is provided with information indicating that an applicant’s name is on the State Central Registry as a perpetrator with a justified finding of abuse and/or neglect, they may request a clearance of the SCR without the applicant's permission.
  • Notification of Non-compliance: Should an applicant fail to comply with the SCR disclosure requirements, and their name is found on the SCR as described, the department will notify both the employer (the named facility) and the appropriate District Attorney’s office of this non-compliance.

Understanding and adhering to these points ensures that individuals and facilities comply with the law, contributing to the safety and well-being of children in their care. It's essential for everyone involved to pay careful attention to the accuracy and honesty of the information provided on the SCR Disclosure Form.

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