Caregiver Background Checks Interim Procedures

  1. Department or advisor has intern/volunteer complete an "Authorization & Release Form" and a "Background Information Disclosure Form" (HFS-64).
  2. Department or advisor completes "Wisconsin Criminal History Record Check Request Form" (DJ-LE-250).
  3. Department forwards all documents to University Police in a confidential manner.
  4. University Police will review all documents for completeness and submit the record request to the Wisconsin Dept. of Justice and any other jurisdictions as necessary. University Police will charge back the cost of the background check to the requesting department.
  5. University Police will evaluate and summarize the findings and prepare a package for the requesting department or advisor. The package will include the summary of findings, copies of all forms submitted to University Police, and copies of any information received as a result of the background check
    1. If there are any convictions for "Bar," "Bar-with-Rehab," or for which time limits have not expired, the intern/volunteer will not be referred to the facility.
    2. If there are any convictions for other offenses, the facility must be notified that it must determine if the convictions are "substantially related" to the activities to be performed by the intern/volunteer and whether the facility will accept the intern/volunteer.
    3. University Police will maintain all original caregiver background check documents in a dedicated confidential file.
  6. Department or advisor will notify the intern/volunteer and the facility of the results of the caregiver background check. If there is a "Bar" or "Bar-with-Rehab" or a time limit has not expired, the department or advisor will turn over the package to the student. There is no need to send it to the facility as the University will not be referring the intern/volunteer to the facility.

    In all other cases, the department or advisor will forward the package to the facility. The department or advisor may make a copy of the package for the intern/volunteer if he/she desires a copy.


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