Washington State Department of Social and Health Services Home page

Forms

Applicant Affidavit Form: The Affidavit Form is used by the applicant to provide details for:

  • Crimes reported by the Washington State Patrol (WSP), Washington Courts, Department of Corrections, the Federal Bureau of Investigation (FBI), or other states
  • Self-disclosures made on a Background Authorization Form   

Affidavit No Contact Order Form: If an applicant disclosed in error to question 14 on the Background Authorization Form and needs to clarify that the order did not involve a vulnerable adult or child, they will need to submit an Affidavit No Contact Order Form.

Applicant Request for Background Check Information Form: The applicant can use the Request for Background Check Form to request a copy of their background check results. 

Background Authorization Form with Instructions: The Background Authorization Form is used by multiple DSHS programs to meet varying background check needs. The instructions provide general directions for completing the Background Check Authorization Form. The DSHS program that is requiring the background check may have additional instructions that you must follow.

For English: Word or PDF

For other languages:  Amharic, Arabic, Burmese, Cambodian, Chinese, Dinka, French, Farsi, Karen, Kayah, Kirundi, Korean, Laotian, Marshallese, NepaliNuerOromo, Polish, Punjabi, Russian, Samoan, Serbo-Croatian, SomaliSpanish, Spanish Word, SwahiliTagalog, Tigrigna, Trukese, Ukrainian, Vietnamese