TCP Employee Clearance Submission Sheet:

FY 24/25 DHS Contracts

Please utilize this form to submit the required clearances for each employee's clearance level as included on your program's Staffing List (905) and TCP Staffing/Clearance Identification Sheet.


Note: An updated 905 and TCP Staffing/Clearance Identification Sheet must be submitted to reflect all staff changes.

Provider/Contract Information

Please include the name of your organization.

Please include your program's full name as stated in your contract.

Please include your correct, FY 24 contract number.

Please submit the email(s) of the point-of-contact(s) who will update clearances on a need-be basis.

Employee Information

Active - Employed with agency and listed on Staffing List (905) and TCP Staffing/Clearance Identification Sheet

Inactive - No longer employed with agency and no longer listed on 905 and TCP Staffing/Clearance Identification Sheet


Note: Please submit a new Staffing List 905 and TCP Staffing/Clearance Identification Sheet whenever there are any staff changes.

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Please include the start of employment for the staff member.

Please visit https://community-partnership.org/wp-content/uploads/2024/03/TCP-Provider-Employee-Background-Clearance-Policy-4.pdf to learn more about each clearance level.

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Please submit the date that the employee's FBI background check was administered.

Please submit the date that the FBI background check will be renewed.

Note: FBI background checks are to be conducted every 2 years from the time of expiration for Safety Sensitive and Protection Sensitive Positions and are required every 4 years for Security Sensitive Positions.

Please submit the date that the employee's MPD background check was administered.

Please submit the date that the MPD background check will be renewed.

Note: MPD background checks are to be conducted every 2 years from the time of expiration for Safety Sensitive and Protection Sensitive Positions and are required every 4 years for Security Sensitive Positions.

Please submit the date that the employee's CFSA background check was administered.

This is a requirement for all providers who work with youth or family programs.

Please submit the date that the CFSA background check will be renewed.

Note: CFSA background checks are to be submitted every 2 years from the date in which the last clearance was checked/pulled.

Please submit the date that the employee's NSO background check was administered.

Please submit the date that the NSO Check will be renewed.

Note: NSO background checks are to be submitted every 2 years. Therefore, the date of renewal should be two years after the last NSO background check was conducted.

A Traffic Record Check is only applicable if the employee drives as part as their routine work duties.

Please submit the date that the Traffic Record Check will be renewed. *Note: This clearance is required every 2 years if the employee drives as part of their routine duties.

Please note that Drug and Alcohol Tests are required at the time of hire, for reasonable suspicion, post-accident or incident, return to duty and randomly. TCP now requires its providers to complete random drug and alcohol testing annually.

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Please submit the date that the TB Test was administered.

Please submit the date that the TB Test will be renewed. This date should be two (2) years after the last test was conducted unless a chest x-ray was conducted. Please note that TB tests conducted in the form of a chest x-ray are good for 5 years.

Please submit all clearances required for the employee's clearance level in the below order:


Safety Sensitive:

  1. FBI Background Check (required every 2 years)
  2. MPD Background Check (required every 2 years)
  3. CFSA Clearance (required every 2 years only for employees that work for youth or family programs)
  4. National Sex Offender Registry (required every 2 years)
  5. Traffic Record Check (required every 2 years if the employee drives as part of their routine duties)
  6. Random Drug/Alcohol Screening (required annually)


Protection Sensitive:

  1. FBI Background Clearance (required every 2 years)
  2. MPD Background Clearance (required every 2 years)
  3. Traffic Record Check (required every 2 years if the employee drives as part of their routine duties)
  4. Random Drug/Alcohol Screening (required annually)
  5. TB test (required every 2 years) *Please note that if an employee's TB screening comes back positive, a physical is required.



Security Sensitive:

  1. FBI Background Clearance (required every 4 years)
  2. MPD Background Clearance (required every 4 years)
  3. Traffic Record Check (required every 2 years if the employee drives as part of their routine duties)
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