Digital Fingerprinting Request Questionnaire

Please select YES or NO to the following questions.

1. Do you have access to the Background Check Information System (BCIS)?*

Yes
No

2. Does your site have a closed room with no foot traffic? (No foot traffic means that no other person will be entering or leaving the designated room under any circumstance. Only the person being fingerprinted will be allowed in the room.)*

Yes
No

The space can be an unused classroom, empty office, or conference room.  The space should not be a break room or a room used as storage. In order to ensure privacy during the session, any staff not being fingerprinted should not enter the room. 

You will need to upload a photo of the space for review. Please include photos of the furniture (adult sized table & chairs) that will be used the day of your session.

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

The room requirements are required in order to ensure privacy for the appointments. Staff will NOT conduct the session in a room that does not meet these requirements.

3. Does the room have adult-sized table and chairs?*

Yes
No

4. Does the room have an electrical outlet for our equipment without the need for an extension cord?*

Yes
No

5. Does the room meet standard environmental requirements (heat, air conditioning, ventilated)?*

Yes
No

6. Are you willing to allow area childcare providers who need this service to fill any unused appointment times?*

Yes
No

Your staff will be given priority before any additional appointment times are opened to area child care providers. 

7. Is the location currently licensed or applying to become licensed?*

Yes
No

Please complete the following questions

8. How many staff members need appointments?*

We ask that there be a minimum of 6 staff members that need to have their fingerprints collected.  

9. What is the name of your site?*

10. What your site's address?*

Street Address City State ZIP Code

11. License Number*

Please only enter the numbers only.

12. What is the name of the Session Contact? *

First Last

Email*

Phone*

WE WILL USE THIS NUMBER TO CONTACT YOU IN CASE OF EMERGENCY, INCLEMENT WEATHER, OR SAME-DAY CANCELLATION.

Will the session contact person be on site the day of the session?*

Yes
No

A staff member from the Host Site must remain on the premises for the entire session.

What is the name of the Onsite Contact? *

First Last

ONLY if different from the Session Contact

Email*

Phone*

14. Is there anything we should know about your location (such as parking, instructions upon arrival, health & safety protocols)? *

A typical session is scheduled between 10:00 AM and 3:00 PM Monday through Friday. If a different time or day is needed, please enter that information here.

16. Are there any food restrictions? *

Our staff members are required to stay with our equipment at all times. Therefore, they will be eating their lunch in the space provided.

Important*

I agree to adhere to all due dates.

During the scheduling process and prior to your session we will need you to complete the required documentation by due dates. Please be aware that we cannot conduct the session if required documentation isn’t received by the requested dates

Important*

I agree to meet all room requirements (no foot traffic, adult-sized table and chairs, etc.)

If your space does not meet our requirements, the fingerprinting staff will not be able to conduct your session.

Important*

I understand that a completed appointment schedule will need to be submitted before United Way of CT can offer a session date.

The appointment schedule should be sent to fingerprinting@unitedway.org and must include each staff member’s full name, DOB, email, phone number and Applicant Tracking Number.