• Written Authorization to Request a CAPS Check

    Pursuant to §26-3.1-111, C.R.S., certain employers named in the statute are required to request a check of the Colorado Adult Protective Services (APS) data system (CAPS) prior to hiring a new employee who will be providing direct care to at-risk adults. These employers are also authorized by statute, though not required, to request a CAPS check for current employees. The CAPS check will alert the employer as to whether or not a prospective or current employee has been substantiated as a perpetrator of physical abuse, sexual abuse,

    caretaker neglect, and/or exploitation of an at-risk adult. More information on the CAPS check requirement can be found in Title 26, Article 3.1 of the Colorado Revised Statutes (C.R.S and 12 CCR 2518-01 of the Colorado Code of Regulations (CCR Written authorization from the applicant/employee using this form is required per APS regulations (12 CCR 2518-1 Please complete this entire form. It is recommended that you and the employer keep a copy of this form for your records.

  • EMPLOYER INFORMATION

  • REQUESTOR INFORMATION

  • APPLICANT/EMPLOYEE INFORMATION

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  • RACE/ETHNICITY (Check all that apply):

  • All Applicants/Employees are required to have 5 years of residential history provided. If the individual listed above has less than 5 years at their current address, please list the previous addresses for the past 5 years. Use another sheet of paper, if necessary.

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  • By my signature, below, I attest that all information provided in this written authorization is true and complete. My signature authorizes the employer referenced above to request a CAPS Check to determine if I have been substantiated in an APS case as a perpetrator of physical abuse, sexual abuse, caretaker neglect, and/or exploitation of an at-risk adult. I acknowledge that the information resulting from such a check will be shared directly with the employer who may use the results to inform their hiring decision. By my signature I acknowledge that this request will flag my name to allow notification to this employer of any future substantiated findings as long as I am employed by this agency.

  • ADDITIONAL BACKGROUND CHECK PERMISSION

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  • Should be Empty: