The 2602 Form is a crucial document used in New Hampshire for individuals seeking authorization for their criminal history record information, particularly in the context of child care licensing. This form ensures that the necessary background checks are conducted to promote the safety and well-being of children in licensed care. If you're ready to fill out the 2602 form, click the button below!
The 2602 form is an essential document for individuals seeking a license exemption in child care within New Hampshire. This form is specifically designed for those who need to authorize the release of their criminal history record information. It is crucial for both new applicants and those renewing their licenses, as it ensures that all required background checks are conducted. Applicants must provide personal information, including their name, address, and date of birth, which must be clearly typed or printed. Additionally, the form includes sections for applicants to indicate their preference for fingerprinting—either via Livescan or inked prints—along with the associated fees. The form also requires a signature to certify the accuracy of the provided information, which is a critical step in the application process. If the criminal record needs to be mailed to someone other than the applicant, further authorization is necessary, including a notary's signature. Understanding the components and requirements of the 2602 form is vital for anyone navigating the child care licensing process in New Hampshire.
STATE OF NEW HAMPSHIRE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION FOR CHILDREN, YOUTH & FAMILIES
129 PLEASANT STREET, CONCORD, NH 03301-3857
Nicholas A. Toumpas
603-271-4451 1-800-852-3345 Ext. 4451
FAX: 603-271-4729 TDD Access: 1-800-735-2964
Commissioner
Maggie Bishop
Director
NEW HAMPSHIRE HEALTH AND HUMAN SERVICES CRIMINAL HISTORY RECORD INFORMATION AUTHORIZATION
LICENSE EXEMPT CHILD CARE FORM NH RSA 170-E:4
LIVESCAN-$16.50
OR
INKED-$16.50
MUST SELECT ONE
APPLICANTS ARE RESPONSIBLE FOR THIS FEE
NEW APPLICANT (Fingerprints are required)
RENEWAL (Fingerprints NOT required)
SECTION I
PLEASE TYPE OR PRINT CLEARLY, ALL INFORMATION IN THIS SECTION MUST BE COMPLETED
NAME
LAST
MAIDEN/ALAIS
FIRST
MI
ADDRESS
STREET
CITY
STATE
ZIP CODE
DATE OF BIRTH
HAIR COLOR
EYE COLOR
SEX
DRIVER LICENSE NUMBERSTATE
My signature below certifies I am the individual listed above and that the information provided is true.
YOUR SIGNATURE:
DATE
Signed under penalty of unsworn falsification pursuant to NH RSA 641:3.
SECTION II
IF RECORD IS TO BE MAILED TO YOU, OR RECEIVED BY SOMEONE OTHER THAN YOURSELF,
ALL OF SECTION II MUST BE COMPLETED
I hereby authorize the release of my criminal record conviction(s), if any, to the following:
NH Division for Children, Youth and Families Bureau of Child Development
129 Pleasant Street, Concord NH 03301
YOUR SIGNATURE
NOTARY ‘S SIGNATURE
(AFFIX SEAL)
(COMM. EXP)
Enrollment Specialist, Child Development Bureau, DCYF
SIGNATURE OF PERSON/FIRM TO RECEIVE RECORD
NOTE: Make checks payable to: State of NH – Criminal Records.
Applicant fingerprint card must be submitted at the same time as payment and this form.
Form 2602
PD 12-34
July 2012
What is the purpose of the 2602 form?
The 2602 form, also known as the Criminal History Record Information Authorization License Exempt Child Care Form, is used in New Hampshire to authorize a background check for individuals applying for or renewing a license to provide child care services. This form helps ensure the safety of children by allowing the state to review any criminal history associated with the applicant.
Who needs to complete the 2602 form?
Any individual seeking to become a licensed child care provider in New Hampshire must complete the 2602 form. This includes new applicants who are required to submit fingerprints, as well as those renewing their licenses, who do not need to provide fingerprints again. Accurate completion of the form is essential for processing the background check.
What information is required on the 2602 form?
The form requires personal information such as your full name, address, date of birth, hair color, eye color, sex, and driver's license number. Additionally, if you want the results of your criminal history check sent to someone other than yourself, you must provide their details in Section II. All sections must be filled out clearly and accurately to avoid delays in processing.
What are the fees associated with the 2602 form?
There is a fee of $16.50 for processing the criminal history check, regardless of whether you choose to use Livescan or inked fingerprints. This fee is the responsibility of the applicant. Payment must be submitted alongside the completed 2602 form and any necessary fingerprint cards to ensure your application is processed without delays.
This form is used for both new applicants and renewals. While new applicants must provide fingerprints, those renewing their application do not need to submit them again.
A signature is essential on the form. It certifies that the information provided is accurate and true, and it is required under penalty of unsworn falsification.
The fee is mandatory. Applicants must select either the Livescan or inked fingerprint option and are responsible for paying this fee at the time of submission.
This is correct; however, for new applicants, fingerprints are required. Renewal applicants can skip this step.
All sections of the form must be filled out completely. Incomplete forms may delay the processing of the application.
Applicants must authorize the release of their records and provide the necessary mailing information in Section II if they wish to receive it directly.
This form must be submitted in person or via mail. Electronic submissions are not accepted due to the requirement for signatures and fingerprints.
The notary's signature is required if the record is to be mailed to someone other than the applicant. This ensures the authenticity of the request.
While the form is specific to New Hampshire, individuals from outside the state may also need to use it if they are applying for a child care license in New Hampshire.
Form 2603: Child Care Provider Background Check Authorization - This form is used to authorize background checks for child care providers. Like Form 2602, it requires personal information and consent for record checks.
Form 2604: Child Care Licensing Application - This document is similar in that it involves the licensing process for child care facilities. It also requires detailed personal information and adherence to state regulations.
Form 2605: Child Care Provider Registration Form - This form registers child care providers with the state. It shares similarities with Form 2602 in terms of information collection and verification of the applicant's identity.
Form 2606: Child Abuse and Neglect Background Check - This document is used for background checks specifically related to child abuse. It parallels Form 2602 by requiring consent and personal details for processing.
Form 2607: Criminal Record Request Form - This form requests a criminal record check. It is similar to Form 2602 in that both require the applicant's signature and personal information for verification purposes.
Form 2608: Employment History Verification Form - This document verifies employment history for child care workers. Like Form 2602, it requires detailed information about the applicant's background.
Form 2609: Fingerprint Submission Form - This form is used to submit fingerprints for background checks. It is similar to Form 2602 as both involve fingerprinting for security clearance.
Form 2610: Child Care Training Documentation Form - This document tracks training for child care providers. It shares similarities with Form 2602 in its focus on compliance and regulatory requirements for child care professionals.
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