Screening
Required for anyone working in a licensed childcare program in North Carolina.
Certify and sign
I certify that I have given true, accurate, and complete information on this form to the best of my
knowledge. If confirmation is needed in connection with my work, I authorize educational institutions,
associations, registration and licensing boards, and others to furnish whatever detail is available
concerning my qualifications. I authorize investigation of all statements made in this application, and
I understand that false information or documentation, or a failure to disclose relevant information,
may be grounds for rejection of my application, disciplinary action, or dismissal if I am employed.
Your files upload first, then the application is sent. Large files can take a moment.