CPS Background/Adam Walsh Background Clearance Request Submission Page

Maryland Camps, Public Schools, and other Child Serving Agencies must use the myDHR Portal for submissions. Submissions for Maryland Camps, Public Schools, and other Child Serving Agencies will not be processed if submitted through this portal. If you do not have access to the myDHR Portal, please review the instructions here.

Kindly submit only one request per employer or requestor. Duplicate submissions may result in delays in receiving a response

Are you submitting a request on behalf of a Maryland Camp, Public School or other Child Serving Agency?

Yes

Applicant’s Last Name

Applicant's First Name

Requesting Agency's Name

Requesting Agency Email Address

If requesting for self, provide applicant's email

Applicant Email Address

Optional: If you provided the Requesting Agency's Email Address, you may provide the applicant's email address in this field

Is the requestor an employee of a State Department of Social Services?

Yes

Does the applicant currently reside in Maryland?

Yes

Has the applicant been issued a Social Security Number?

Yes

Submission checklist:

(Please use this checklist to ensure that your Background Clearance Application has been fully completed)

Part I A&B: Has the Purpose of Search been completed?

Yes

Part II: Has the following search information been completed?

Full Name (Including Maiden/Birth Name and/or Other Names Used)

Address

Date of Birth

Part III: Has the agency or individual, as listed in Part I, been identified in Part III as the party authorized to receive results?

Yes

Part IV: Has the individual's printed name and signature been completed with the Date of Authorization?

Yes

Part V: Has the Certificate of Acknowledgement of Individual been completed?

Notary Signature

Notary Stamp/Certificate

Note: If any of the boxes above cannot be checked, your application will be considered incomplete and returned with a Missing Information Form explaining what required information is missing from the request form.

Purpose of Search

Upload completed, signed, and notarized Adam Walsh Background Clearance Application here:

Drop your files here

If you have questions, please send them to mdcps.clearances1@maryland.gov.

Send me a copy of my responses

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