Fingerprint Submission Guidance for ADHC CBAS
This document provides essential guidance for the fingerprint submission process necessary for ADHC/CBAS employment. It outlines the requirements, necessary forms, and who is involved in completing the criminal record clearance. Follow the instructions carefully to ensure compliance with California law.
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How do I fill this out?
To fill out this form, first download the required applications from the provided links. Make sure to complete all sections accurately, as incomplete forms will delay the processing. Finally, submit the forms to the specified address to initiate your fingerprint submission process.

How to fill out the Fingerprint Submission Guidance for ADHC CBAS?
1
Download the necessary forms from the provided links.
2
Complete the forms accurately, ensuring all required information is included.
3
Visit a Live Scan service site with your completed forms.
4
Submit the completed transmittal and Live Scan forms as instructed.
5
Await confirmation of your criminal record clearance.
Who needs the Fingerprint Submission Guidance for ADHC CBAS?
1
Program Administrators need this form for compliance with state laws.
2
Directors of Community-Based Adult Services must submit this for employment eligibility.
3
Fiscal Officers require this to verify a clean criminal record.
4
New applicants in high-risk Medi-Cal services must ensure they clear the background check.
5
Individuals with significant ownership interests in providers need to submit fingerprints for compliance.
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What are the important dates for this form in 2024 and 2025?
Key dates for compliance with this form include: January 1, 2024, when new applications start, and annual compliance checks thereafter. Individuals must submit fingerprints within 30 days upon requests starting in 2025.

What is the purpose of this form?
The primary purpose of this form is to facilitate the fingerprint submission process required for employment in ADHC/CBAS roles. It ensures that those working with vulnerable populations have undergone appropriate background checks. This contributes to the overall safety and integrity of the services provided.

Tell me about this form and its components and fields line-by-line.

- 1. Personal Information: Collects basic identifying information like name, address, and contact details.
- 2. Criminal Record Clearance: Contains fields for the results of the background check process.
- 3. Signatures: Requires signatures from the applicant and authorized personnel.
What happens if I fail to submit this form?
If the form is not submitted, individuals may face delays in their employment process or potential disqualification from positions. It is crucial to adhere to timelines to avoid repercussions.
- Employment Delays: Failure to submit on time can lead to waiting periods for job placements.
- Legal Penalties: Non-compliance may result in legal consequences under California Health and Safety Code.
- Client Safety Risks: Inadequate background checks could compromise the safety of vulnerable clients.
How do I know when to use this form?

- 1. New Employment: Required for individuals starting new jobs at ADHC/CBAS facilities.
- 2. Position Changes: Necessary when there are changes to key administrative roles.
- 3. Licensing Requirements: Used to meet compliance for licensure with state health authorities.
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