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Mailing Checklist

DO NOT send in a fingerprint card or attempt to schedule a fingerprinting appointment until you have FIRST paid all application fees and submitted your application to the appropriate Health Licensing Board.

  1. FORM 1—Informed Consent: Criminal Background Check for Licensure
    1. All information filled out?
    2. Signed and dated by you?
  2. FORM 2—Informed Consent: Release of Predatory Offender Registration Data
    1. All information filled out?
    2. Signed and dated by you?
  3. FORM 3—Identity Verification Form
    1. All information filled out?
    2. Person who took your fingerprints personally reviewed your valid government-issued photo ID at time of fingerprinting?
    3. Signed and dated by you, while being observed by the person who took your fingerprints, immediately prior to fingerprinting?
    4. Signed and dated by the person who took your fingerprints, immediately prior to fingerprinting?
    5. PLEASE NOTE: The CBC Program Office cannot accept prints not accompanied by a completed Form 3, accompanied by a Form 3 on which the signatures and dates do not match those on the accompanying fingerprint card, or by a Form 3 which is missing information on the form of government-issued photo ID used for identity verification. If you took fingerprints previously, those cannot be reused for the Minnesota Health Licensing Boards' required CBC.
  4. Hardcopy fingerprint card
    1. You must submit a hardcopy fingerprint card (type FD-259), unless you have your fingerprints taken at the Minnesota HLB Criminal Background Check Program office.
    2. Do not fold or staple fingerprint card.
    3. All required fields completed per instructions?
    4. Correct ORI number for MN Board printed (or handwritten) on card?
    5. Signed by you, while being observed by person who took your fingerprints?
    6. Signed and dated by person who took your fingerprints?
  5. Write your applicable MN Board name in parentheses below your return address on the envelope you use to send us your materials. This speeds mail sorting and saves time in processing your background check.

    YOURNAME
    YOURSTREET
    YOURCITY, YOURSTATE YOURZIP
    (MN Board of _______)

  6. Use appropriate postage and send your materials to:

    Criminal Background Check Program
    2829 University Ave SE Ste 555
    Minneapolis, MN 55414-4202

NOTE: To avoid delay, mail your materials directly to the Criminal Background Check Program. Do not send them to your Health Licensing Board, or it will delay the background check.

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