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Background Check Forms

Click on any of the Background Check Links below to download the form in .PDF Format.

If you need to get a .pdf file reader you can Click here to download Acrobat for free.

Be sure you pick the correct Background Check form before completing and submitting to Kentucky State Police

Employment

All employers who do not have a KRS requiring a criminal records check for pre-employment purposes should use this form:

Click here to download Request For Conviction Records/Employment

Adoption/Foster Care

Any adoption not being processed through the Cabinet for Health and Family Services should use this form:

Click here to download Request For Conviction Records/ Adoptions and Foster Homes

Minors

Any agency with a position that requires an individual to have disciplinary power over a child should use this form:

Click here to download Request For Conviction Records//Minors

Long-Term Care Facility

Any state licensed long-term care facility, nursing pool providing staff to a nursing facility, or assisted-living community, involving direct services to a resident or client should use this form:

Click here to download Request For Conviction Records/Long-Term Care Facility

Childcare

All state licensed child care facilities should use this form:

Click here to download Request For Conviction Records/Child Care

Emigration

Individuals emigrating to a foreign country that requires a criminal records check should use this form:

Click here to download Request For Conviction Records/ Emigration

Fire/Ambulance Service / Rescue Squad

All Fire Departments (certified by the Commission on Fire Protection Personnel Standards and Education), Ambulance Services (licensed by the Commonwealth of Kentucky), or Rescue Squads (officially affiliated with a local disaster and emergency services organization or with the Division of Emergency Management) should use this form:

Click here to download Request For Conviction Records/Fire Department, Ambulance Service, Rescue Squad

Housing

Anyone applying for housing assistance and has been directed to conduct a criminal records check through the KSP should use this form. (Not all housing assistance providers accept KSP criminal records checks):

Click here to download Request For Conviction Records/Housing

For further assistance please call the KSP Criminal Records Dissemination Section at (502) 227-8713 Monday-Friday 8:00 am - 4:30pm.

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