Form CFS 718, Authorization for Background Check Instructions

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This form contains 120 fields organized into 27 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Age
Age Text
Provide the current age of the individual in years.
Cell Phone
Cell Phone Area Code Text
Provide the three-digit area code for the cell phone number.
Max length: 3 characters
Cell Phone Prefix Text
Provide the three-digit prefix for the cell phone number.
Max length: 3 characters
Cell Phone Line Number Text
Provide the four-digit line number for the cell phone number.
Max length: 4 characters
Child Abuse/Neglect Investigation History
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 your country of citizenship is the USA.
Other Checkbox
Check this box if your country of citizenship is not the USA and specify the country.
Other Citizenship Country Text
Enter the name of your country of citizenship if it is not USA. Fill only if 'Other' is 'Yes'.
Depends on: Other
Criminal Offense History
Yes Checkbox
Check this box if you have ever been convicted of a criminal offense, excluding minor traffic violations.
No Checkbox
Check this box if you have never been convicted of a criminal offense, excluding minor traffic violations.
Current Address
Street Address and Apartment Number Text
Enter your current street address and apartment number.
City Text
Enter the city of your current address.
State Text
Enter the state of your current address.
Max length: 2 characters
Zip Code Text
Enter the five-digit or nine-digit zip code for your current address.
Max length: 5 characters
County Text
Enter the county of your current address.
Date of Birth
Date of Birth Month Text
Please provide the month of birth.
Max length: 2 characters
Date of Birth Day Text
Please provide the day of birth.
Max length: 2 characters
Date of Birth Year Text
Please provide the year of birth.
Max length: 4 characters
Ethnicity
Ethnicity Text
Enter your ethnicity or the corresponding code as referenced on Page 2.
Fifth Past Address
Fifth Past Address Text
Provide the street, apartment number, city, state, and zip code for the fifth past address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Fifth Past Address Dates Text
Provide the start and end dates of residence for the fifth past address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
First Past Address
First Past Address Text
Provide the street address, apartment number, city, state, and zip code for this past address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
First Past Address Dates Text
Enter the start and end dates for the period during which you resided at this address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Formerly Used Names
Formerly Used Name 1 Text
Please enter the first formerly used name, including last name, first name, and middle initial.
Formerly Used Name 2 Text
Please enter the second formerly used name, including last name, first name, and middle initial.
Fourth Past Address
Fourth Past Address From Date Date
Please provide the start date of the fourth past address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Fourth Past Address To Date Date
Please provide the end date of the fourth past address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Full Name
Last Name Text
Please provide your last name.
First Name Text
Please provide your first name.
Middle Initial Text
Please provide your middle initial.
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
Text106 Text
Text107 Text
Text108 Text
Text109 Text
Printed Last Name Text
Enter the last name of the individual to be printed.
Printed First Name Text
Enter the first name of the individual to be printed.
Printed Middle Initial Text
Enter the middle initial of the individual to be printed.
Provider ID Text
Enter the unique identification number for the provider.
Home Telephone
Home Telephone Area Code Text
Please enter the three-digit area code of 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
Outside Illinois Residence Inquiry
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.
Person in the Facility
Applicant/Operator Checkbox
Check this box if the person is an Applicant/Operator applying to operate a licensed child care facility.
Executive Director Checkbox
Check this box if the person is an Executive Director.
Employee/Volunteer Checkbox
Check this box if the person is an Employee or a Volunteer.
Physical Description
Height Inches Text
Please enter the height in inches.
Weight Number
Please enter the weight in pounds.
Hair Color Text
Please enter the hair color.
Eye Color Text
Please enter the eye color.
Place of Birth
Place of Birth Text
Please enter the city and state where you were born.
Printed Name
Text106 Text
Text107 Text
Text108 Text
Printed Name Text
Enter your full printed name, including last name, first name, and middle initial.
Provider ID Number (Left) Text
Enter the provider identification number in the left field.
Provider ID Number (Right) Text
Enter the provider identification number in the right field.
Provider ID
Text109 Text
Provider ID Number Text
Please enter the unique identification number assigned to the provider.
Race
Native American/Alaskan Checkbox
Check this box if the individual identifies as Native American or Alaskan (Indian or Eskimo).
Tribal Affiliation Yes Checkbox
Check this box if the individual has a tribal affiliation. Fill only if 'Native American/Alaskan' is 'Yes'.
Depends on: Native American/Alaskan
Tribal Affiliation No Checkbox
Check this box if the individual does not have a tribal affiliation. Fill only if 'Native American/Alaskan' is 'Yes'.
Depends on: Native American/Alaskan
Black/African American Checkbox
Check this box if the individual identifies as Black or African American.
Native Hawaiian/Pacific Islander Checkbox
Check this box if the individual identifies as Native Hawaiian or Pacific Islander.
Asian Checkbox
Check this box if the individual identifies as Asian.
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 provide their race.
Could not be Verified Checkbox
Check this box if the individual's race could not be verified.
Second Past Address
Second Past Address Text
Please provide the complete second past address, including street, apartment number, city, state, and zip code. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Second Past Address Dates Text
Please provide the 'From' and 'To' dates for the second past address. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Sex
Male Checkbox
Check this box if your sex is male.
Female Checkbox
Check this box if your sex is female.
Social Security or ITIN Number
Social Security or ITIN Number (First Part) Text
Please provide the first five digits of your Social Security Number or ITIN.
Max length: 5 characters
Social Security or ITIN Number (Last Part) Text
Please provide the last four digits of your Social Security Number or ITIN.
Max length: 4 characters
Specific Type of Application
Youth Transitional Housing Program Checkbox
Check this box if the application is for a Youth Transitional Housing Program.
Group Home Checkbox
Check this box if the application is for a Group Home.
Child Care Institution/Maternity Center Checkbox
Check this box if the application is for a Child Care Institution or Maternity Center.
Youth Emergency Shelter Checkbox
Check this box if the application is for a Youth Emergency Shelter.
Secure Child Care Facility Checkbox
Check this box if the application is for a Secure Child Care Facility.
Child Welfare Agency Checkbox
Check this box if the application is for a Child Welfare Agency.
Third Past Address
Past Address Details Text
Please provide the complete street address, apartment number, city, state, and zip code for a previous residence where you lived within the last five years. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes
Dates Lived At Address Text
Please provide the start and end dates (From/To) you lived at this previous address. Fill only if 'Yes' is 'Yes'.
Max length: 2 characters
Depends on: Yes