CFS 508-1, Authorization for Background Check Instructions

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This form contains 139 fields organized into 34 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Adoption - Application Type
Adopt Only Home Checkbox
Check this box if the application type is for an 'Adopt Only Home' under the adoption category.
Unlicensed Relative in Illinois Checkbox
Check this box if the application type is for an 'Unlicensed Relative in Illinois' under the adoption category.
Unlicensed Relative Out of State Checkbox
Check this box if the application type is for an 'Unlicensed Relative Out of State' under the adoption category.
Adoption - Person in Home
For Placement Purposes Checkbox
Check this box if the person in the home is being screened for placement purposes related to adoption.
For Adoption Purposes Checkbox
Check this box if the person in the home is being screened for adoption purposes.
Age
Age Text
Please enter the current age of the individual.
Applicant Name
Applicant Last Name Text
Please provide the last name of the applicant.
Applicant First Name Text
Please provide the first name of the applicant.
Applicant Middle Initial Text
Please provide the middle initial of the applicant.
Cell Phone
Cell Phone Area Code Text
Please enter the three-digit area code for your cell phone.
Max length: 3 characters
Cell Phone Prefix Text
Please enter the three-digit prefix of your cell phone number.
Max length: 3 characters
Cell Phone Line Number Text
Please enter the four-digit line number of your cell phone number.
Max length: 4 characters
Child Abuse Investigation Question
Yes Checkbox
Check this box if you have ever been indicated as a perpetrator in a child abuse or neglect investigation.
No Checkbox
Check this box if you have never been indicated as a perpetrator in a child abuse or neglect investigation.
Citizenship
USA Checkbox
Check this box if the applicant's citizenship is USA.
Other Specify Checkbox
Check this box if the applicant's citizenship is not USA and you need to specify another country.
Other Citizenship Country Text
Please specify your country of citizenship if it is not USA. Fill only if 'Other Specify' is 'Yes'.
Depends on: Other Specify
Criminal Offense Question
Yes, convicted of criminal offense Checkbox
Check this box if you have ever been convicted of a criminal offense, other than a minor traffic violation.
No, not convicted of criminal offense Checkbox
Check this box if you have never been convicted of a criminal offense, other than a minor traffic violation.
Current Address
Street Address Text
Please enter the street address and apartment number for the current residence.
City Text
Please enter the city of the current residence.
State Text
Please enter the state of the current residence.
Max length: 2 characters
Zip Code Text
Please enter the zip code for the current residence.
Max length: 5 characters
County Text
Please enter the county of the current residence.
Date of Birth
Birth Month Text
Enter the month of birth.
Max length: 2 characters
Birth Day Text
Enter the day of birth.
Max length: 2 characters
Birth Year Text
Enter the year of birth.
Max length: 4 characters
Driver's License Number
DL Number Part 1 Text
Provide the first segment of your driver's license number. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
DL Number Part 2 Text
Provide the second segment of your driver's license number. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
DL Number Part 3 Text
Provide the third segment of your driver's license number. Fill only if 'Yes' is 'Yes'.
Max length: 4 characters
Depends on: Yes
Ethnicity Code
Ethnicity Code Text
Provide the ethnicity code as listed on Page 2.
Eye Color
Eye Color Text
Please enter the color of your eyes.
Fifth Previous Address
Fifth Previous Address Text
Please enter the street number, apartment number, city, county, state, and zip code for the fifth previous address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Fifth Previous Address Dates From To Text
Please enter the start and end dates for the fifth previous address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
First Previous Address
Previous Address Text
Please provide the full previous address, including street, apartment number, city, county, state, and zip code. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Previous Address Dates Text
Please enter the start and end dates for how long you resided at this previous address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Formerly Used Names
Former Name 1 Text
Enter the first formerly used name, including the last name, first name, and middle initial.
Former Name 2 Text
Enter the second formerly used name, including the last name, first name, and middle initial.
Foster Care - Application Type
Initial Application Checkbox
Check this box if this is the initial application for foster care.
Renewal Application Checkbox
Check this box if this is a renewal application for foster care.
Relative Placement Application Checkbox
Check this box if the application is for a relative placement in foster care.
Traditional Foster Care Application Checkbox
Check this box if the application is for traditional foster care.
ICPC Application Checkbox
Check this box if the application is for Interstate Compact on the Placement of Children (ICPC) foster care.
Foster Care - Person in Home
Applicant Checkbox
Check this box if the person in the home undergoing the background check is the primary applicant for foster care.
Member of Household (ages 13 through 17) Checkbox
Check this box if the person in the home undergoing the background check is a household member between 13 and 17 years old.
Member of Household (age 18 and over) Checkbox
Check this box if the person in the home undergoing the background check is a household member who is 18 years of age or older.
Youth in Care Checkbox
Check this box if the person in the home undergoing the background check is a youth who is currently in care.
Foster Children Transport Question
Yes Checkbox
Check this box if you are or will be transporting foster children.
No Checkbox
Check this box if you are not and will not be transporting foster children.
Fourth Previous Address
Fourth Previous Address Text
Please provide the complete street address, apartment number, city, county, state, and zip code for the fourth previous address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Fourth Previous Address Dates Text
Please provide the start and end dates for the period you resided at the fourth previous address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Gender
Male Checkbox
Check this box if the individual's gender is male.
Female Checkbox
Check this box if the individual's gender is female.
General
Text22 Text
Max length: 1 characters
Text23 Text
Max length: 1 characters
Text24 Text
Max length: 1 characters
Text25 Text
Max length: 1 characters
Text26 Text
Max length: 1 characters
Text27 Text
Max length: 1 characters
Text28 Text
Max length: 1 characters
Text30 Text
Max length: 1 characters
Text31 Text
Max length: 1 characters
Text32 Text
Max length: 1 characters
Text33 Text
Max length: 1 characters
Text34 Text
Max length: 1 characters
Text35 Text
Max length: 1 characters
Text36 Text
Max length: 1 characters
Text37 Text
Max length: 1 characters
Text38 Text
Max length: 1 characters
Text39 Text
Max length: 1 characters
Text40 Text
Max length: 1 characters
Text41 Text
Max length: 1 characters
Text42 Text
Max length: 1 characters
Text43 Text
Max length: 1 characters
Text44 Text
Max length: 1 characters
Text45 Text
Max length: 1 characters
Text46 Text
Max length: 1 characters
Text47 Text
Max length: 1 characters
Text48 Text
Max length: 1 characters
Text49 Text
Max length: 1 characters
Text50 Text
Max length: 1 characters
Text51 Text
Max length: 1 characters
Text52 Text
Max length: 1 characters
Text53 Text
Max length: 1 characters
Text54 Text
Max length: 1 characters
Text55 Text
Max length: 1 characters
Text56 Text
Max length: 1 characters
Text57 Text
Max length: 1 characters
Text58 Text
Max length: 1 characters
Text60 Text
Max length: 1 characters
Text61#a Text
Max length: 1 characters
Text61#b Text
Max length: 1 characters
Text62 Text
Max length: 1 characters
Text63 Text
Max length: 1 characters
Text64 Text
Max length: 1 characters
Text65 Text
Max length: 1 characters
Text66 Text
Max length: 1 characters
Text67 Text
Max length: 1 characters
Text68 Text
Max length: 1 characters
Text69 Text
Max length: 1 characters
Text70 Text
Max length: 1 characters
Last Name Text
Enter the last name of the individual.
First Name Text
Enter the first name of the individual.
Middle Initial Text
Enter the middle initial of the individual.
Provider ID Text
Enter the provider identification number.
Height
Height (Feet) Number
Please provide the applicant's height in feet.
Height (Inches) Number
Please provide the applicant's height in inches.
Home Telephone
Home Telephone Area Code Text
Please enter the three-digit area code for your home telephone number.
Max length: 3 characters
Home Telephone Prefix Text
Please enter the three-digit prefix of your home telephone number.
Max length: 3 characters
Home Telephone Line Number Text
Please enter the four-digit line number of your home telephone number.
Max length: 4 characters
Illinois Driver's License Question
Yes Checkbox
Check this box if the listed driver's license number is an Illinois Driver's License. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
No Checkbox
Check this box if the listed driver's license number is not an Illinois Driver's License. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Lived Outside Illinois Question
Yes Checkbox
Check this box if you have lived outside of Illinois in the past 5 years.
No Checkbox
Check this box if you have not lived outside of Illinois in the past 5 years.
Place of Birth
Place of Birth (City and State) Text
Provide the city and state where the person was born.
Printed Name
Text106 Text
Text107 Text
Text108 Text
Printed Last Name Text
Enter the last name of the individual as it should be printed.
Printed First Name Text
Enter the first name of the individual as it should be printed.
Printed Middle Initial Text
Enter the middle initial of the individual as it should be printed.
Provider ID
Text109 Text
Provider ID Text
Enter the unique identification number assigned to the provider.
Race
Native American/Alaskan (Indian or Eskimo) Checkbox
Check this box if the individual identifies as Native American/Alaskan (Indian or Eskimo).
Asian Checkbox
Check this box if the individual identifies as Asian.
Black/African American Checkbox
Check this box if the individual identifies as Black/African American.
Native Hawaiian/Pacific Islander Checkbox
Check this box if the individual identifies as Native Hawaiian/Pacific Islander.
White Checkbox
Check this box if the individual identifies as White.
Unknown Checkbox
Check this box if the individual's race is unknown.
Declined to Identify Checkbox
Check this box if the individual declined to identify their race.
Could not be Verified Checkbox
Check this box if the individual's race could not be verified.
Second Previous Address
Second Previous Address Details Text
Please enter the full address, including street number, apartment number, city, county, state, and zip code, for the second previous address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Second Previous Address Dates Text
Please provide the start and end dates for the period you resided at this second previous address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Social Security or ITIN Number
Social Security or ITIN First Part Text
Provide the first three digits of your Social Security or ITIN Number.
Max length: 3 characters
Social Security or ITIN Middle Part Text
Provide the middle two digits of your Social Security or ITIN Number.
Max length: 2 characters
Social Security or ITIN Last Part Text
Provide the last four digits of your Social Security or ITIN Number.
Max length: 4 characters
Third Previous Address
Third Previous Address From Date Date
Please provide the start date for your third previous address listed. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Third Previous Address To Date Date
Please provide the end date for your third previous address listed. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Weight
Eye Color Text
Enter the color of the applicant's eyes.