DCH Fingerprint Authorization Form Atlanta Office

Effective October 1, 2019, prospective owners, administrators, directors, managers as well as job applicants who have direct access to clients will be required to have a criminal background check which includes a state and FBI fingerprint check.

Prosper Home Care requires all new applicants to complete this fingerprint criminal background check within 15 days of being hired. Any applicant who does not complete this check will be removed from employment.

The background check will not cost the applicant any money but does require the applicant to go to an appropriate fingerprinting site and submit to the fingerprinting.

Please complete the following information and answer all questions asked. Sign the form in two separate places and affirm that you authorize this fingerprint background check.

Any applicant that declines to participate in this check will not be offered employment. This is a mandatory state law.

First Name *

Middle Name

Last Name (as listed on social security card) *

Phone Number *

Phone Type *

Permanent Mailing Address *

Apt number

City *

State *

Zip Code *

Email Address *

Social Security Number * 🛈

Date of Birth * +

Height *

Weight *

Eye Color *

Hair Color *

Citizenship Country *

Place of Birth *

Has applicant used any other names such as a maiden name? *

Enter those names here. *

Has applicant lived in another state within the last two years? *

If yes, enter those addresses here. Include residence to and from dates for each address. *