TCP Employee Clearance Submission Sheet:

FY 23 DHS Contracts

Please utilize this form to submit the required clearances for each employee included on your program's Staffing List (905).

 

Staff Member and Provider Information

 
 
 

Active - Employed with agency and listed on Staffing List (905)

Inactive - No longer employed with agency and no longer listed on 905


Note: Please submit a new Staffing List 905 whenever there are any staff changes.

 

Please include the start of employment for the staff member.

 
mm/dd/yyyy
 
 
 
 

Please submit emails of point-of-contacts who will update clearances on a need-be basis.

 

 

Clearances

Please fill out each field and submit clearances in the file upload section.

 

Please note that expired IDs will not be accepted.

 

Please note that TB Tests are to be conducted on an annual basis. Therefore, the expiration date of this clearance will be one (1) year after the date that the test was conducted.

 

Please note that Drug Tests are to be conducted on an annual basis. Therefore, the expiration date of this clearance will be one (1) year after the date that the test was conducted.

 

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

 
mm/dd/yyyy
 

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

 
mm/dd/yyyy
 

Please submit the date that the employee's CFSA background check was administered. This is a requirement for all providers who work with youth.

 
mm/dd/yyyy
 

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

 
mm/dd/yyyy
 

Please submit COVID vaccination dates. If the employee is exempted or does not have the COVID vaccination, please select "N/A".


Note: Johnson & Johnson vaccine only requires one (1) initial dose.

 

Please submit all clearances in a zip folder with the employee's first and last name, in order:


1) Government-Issued Photo ID

2) Tuberculosis (TB) Test

3) Drug Test

4) DC Metro Police (DCMP) Background Check

5) Federal Bureau of Investigation (FBI) Background Check

6) Child and Family Services (CFSA) Background Check

7) National Sex Offender (NSO) Background Check

8) COVID Vaccination Proof

Drop your files here