Child Day Care - Staff Application Fee Form printable pdf download

FAMILY CHILD CARE HOME LICENSE

STAFF INITIAL APPLICATION CHECKLIST

Dear Family Child Care Staff Applicant: Thank you for your interest in wanting to become Family Child Care

Home Staff. Please follow the instructions below to apply for the approval.

Submit an Application Packet Complete each form listed below in blue or black ink and answer all

the questions completely. We will begin processing your application as soon as we receive the Application Fee

and the Application Form. You may send the rest of the forms as soon as they are completed. Background check

responses can take more than 60 days. In order for the OEC to have the legal authority to process the background

check paperwork, you must submit the licensing application form before or with the background check materials.

ALONG WITH THIS APPLICATION, YOU MUST INCLUDE:

$15.00 Application Fee and Fee Invoice Form - Make your check payable to “Treasurer

State of Connecticut”. This fee is not refundable.

“Adult Medical Statement for Child Care”- Physical examination and TB test must have

been within the past year. Adult Medical Statement forms can be found at:

First Aid Certification – A copy of a certificate, front and back, documenting the

successful completion of an approved course in first aid approved for child care providers.

(For substitutes only) A list of approved First Aid Courses can be found at:

References – Submit three Request for Reference Forms to be completed and signed by

individuals (no more than one relative) that have known you for at least three years.

Fingerprints - Submit one fingerprint card (green).

Fingerprint Fee - Enclose a $14.75 check payable to “Treasurer, State of Connecticut” for

each person’s fingerprints. This fee is not refundable.

DCF “Authorization for Release of Information”

If you have obtained this application on-line, please call the Connecticut Office of Early Childhood

@ 860-509-8303 to obtain a fingerprint packet.

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ALL OTHER APPLICATION MATERIALS

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Connecticut Office of Early Childhood

Legal Division

Licensing Division

410 Capitol Avenue #12 CBR

410 Capitol Avenue MS #12 CBR

P.O. Box 340308

Hartford, CT 06134-0308

Child Day Care - Staff Application Fee Form