DSHS 27-089 – Fingerprint Based Background Check Notice

Jurisdiction: Country: United States | Province/State: Washington

What is a DSHS 27-089 – Fingerprint Based Background Check Notice?

The DSHS 27-089 is a notice and instruction form that tells you a fingerprint-based background check is required for your role or application with a Washington social and health services program. It explains why you need to provide fingerprints, how to complete the process, and what happens next. It links your identity to a specific background check request so the results route to the correct agency or employer. In short, it is the official trigger to move you from a name-and-date-of-birth screening to a fingerprint check.

You typically receive this form

• Because you will work with, live with, care for, supervise, or have access to vulnerable adults, children, or sensitive client information under a Washington licensing or contracting program.
• If you are applying for a job, renewing a license, changing roles, or becoming a household member in a licensed setting, this form is common.
• The notice is also used when initial screening can’t confirm your identity with enough certainty, when there are potential record matches that require confirmation, or when the program rules always require fingerprints.

Most often used by

• Caregivers
• Long-term care workers
• Adult family home staff
• Assisted living employees
• In-home care providers
• Case aides
• Behavioral health staff
• Contractors
• Volunteers
• Foster or adoptive applicants connected to services
• Facility administrators

Agency owners and provider administrators use it to track compliance for their staff and household members. If you are a job applicant, new hire, volunteer, or license applicant, you’ll likely fill out the applicant portions and follow the instructions to get printed. If you’re an employer or licensee, you use it to confirm the request details, timelines, and routing numbers so results come back to the right place.

You would need this form to complete a mandatory identity-based background check. Fingerprints allow the state to match your prints against state and national records to verify identity and to ensure the background review is complete and accurate. Without fingerprints, the check may be incomplete and your authorization to work or be licensed can be delayed or denied. Typical usage scenarios include onboarding for a new caregiver position, renewing a clearance that has expired, moving from supervised duties to unsupervised client contact, changing employers within a licensed program, adding a new adult to a licensed household, or resolving an initial background check that returned “inconclusive,” “review required,” or “fingerprints required.”

When Would You Use a DSHS 27-089 – Fingerprint Based Background Check Notice?

You use this notice as soon as you are told that your background check requires fingerprints. If you are starting a job that involves unsupervised contact with clients, your employer will provide this form to complete before you can work alone. If you are a license applicant or facility owner, you use it whenever your role or your staff’s roles trigger the fingerprint requirement. For example, a new caregiver hired at an adult family home receives the notice during onboarding and must get printed before working without supervision. A home care worker changing agencies may receive a fresh notice because the new employer’s request must route through its own account. A facility administrator renewing a license may receive notices for each new household adult or staff member who joined since the last renewal.

If you are a volunteer with regular access to clients, the sponsoring agency will use this notice to move you through the fingerprint process. If your initial name-based check turned up records that need confirmation, the notice serves as the next step to verify whether those records belong to you. If you lived outside Washington during a lookback period, you may be asked to complete fingerprints to ensure national coverage. If you previously had unreadable prints, the notice will tell you to resubmit prints and how to do that without extra cost for the first reprint. If your clearance is time-limited and now expired, the notice marks the start of the renewal check.

In practice, you might receive this form after a conditional hire decision. You may be allowed to start in a limited, supervised capacity while you complete fingerprints. You cannot provide unsupervised care or be alone with clients until your fingerprint results clear. In other cases, especially for certain programs, you must finish fingerprinting before you can begin any duties. If you delay or miss the fingerprint deadline set in the notice, your conditional authorization may end, and the employer or licensing office may remove you from the schedule or pause your application until you comply.

Legal Characteristics of the DSHS 27-089 – Fingerprint Based Background Check Notice

The notice itself is not a contract. It is part of a mandatory regulatory process tied to your job, role, or license. What makes it legally significant is your written authorization and the statutory requirement that certain positions complete fingerprint-based background checks. When you sign the authorization on the form, you permit the state to obtain and share your background information with the requesting agency for eligibility and licensing decisions. Your signature also confirms you understand your rights, including how your information will be used and your opportunity to review and challenge any record attributed to you.

Enforceability comes from program rules that require fingerprinting and from your employer’s or licensing agency’s duty to ensure a clear result before allowing unsupervised access to clients. If you do not complete fingerprinting as required, the agency can deny or withdraw your authorization to work or to hold a license. Employers and licensees can rely on the notice and the results returned under the associated request number in making hiring, retention, and assignment decisions. The notice helps ensure the fingerprint transaction routes correctly to the specific background check request, which is essential for legal compliance and accurate records.

You should also understand the privacy and disclosure limits. Background check results are sent to the authorized requester for eligibility purposes and are not public records for general release. You can ask for a copy of your results from the requester, and you have the right to challenge accuracy with the appropriate record holders if something appears incorrect or incomplete. Certain convictions, findings, or pending matters may be disqualifying under program rules; others may require a character, competence, and suitability review. If your results trigger a review, you may be asked for court documents, proof of completion of requirements, or personal statements. Until a final decision is made, your work may be limited to supervised tasks or paused entirely, depending on the program.

The form may also include notices about data security, retention, and the voluntary nature of some data elements like your Social Security Number. While providing a Social Security Number is often optional, it can help match records and reduce delays when names are common. By signing the form, you confirm the information you provide is accurate. Knowingly providing false information can lead to denial, revocation, or other consequences under program rules and, in some cases, penalties.

How to Fill Out a DSHS 27-089 – Fingerprint Based Background Check Notice

Follow these steps to complete the form and the fingerprint process without delays.

1) Confirm your timeline and responsibilities

• Read the top of the notice. Note any deadline to complete fingerprinting.
• Identify who pays the fingerprint fee. Some employers or programs pay; others require you to pay at the appointment.
• Confirm whether you can work in a supervised capacity while you wait for results. Do not assume. Ask your employer or licensing contact.

2) Gather required identification and details

• Have a valid, government-issued photo ID ready. A driver license, state ID, passport, or similar is typically accepted.
• Gather any prior names you have used, including legal name changes, maiden names, and aliases. Include hyphenations and middle names.
• Collect the request numbers shown on the notice. Common labels include Request ID, OCA, or similar. You will need these to schedule and to ensure your results route correctly.

3) Complete the applicant information section

• Legal name: Enter your full legal name exactly as it appears on your ID. Include first, middle, and last. If you have no middle name, write “No Middle Name” rather than leaving it blank if the form instructs you to do so.
• Other names: List all prior names and aliases you have used. This reduces false matches and speeds processing.
• Date of birth: Use the format shown on the form.
• Place of birth and gender markers: Complete if requested by the form.
• Social Security Number: Provide it if you are comfortable and the form asks for it. It helps matching but is usually optional.
• Contact information: Enter your current mailing address, email, and phone number. Use an email you check often. The agency or employer may use it for follow-up questions.

4) Complete the requesting agency and role information

• Employer or provider name: Use the exact legal or licensed name shown in your onboarding materials or license application.
• Program or facility number: If the notice lists a license or provider number, confirm it matches your employer.
• Agency contact: Add the contact person named on the notice or your onboarding contact, plus their phone and email. This helps the fingerprint vendor or records unit if routing issues arise.
• Role or position: Describe your job title or relationship (employee, contractor, volunteer, license applicant, household member). If the form provides checkboxes, select the one that best fits.

5) Review the background check details on the notice

• Request ID/OCA: Verify the number printed on the notice. Do not alter it. This is the key identifier that links your fingerprints to the correct request.
• Reason for fingerprinting: This may be prefilled based on your role. If it is blank and you are instructed to select a category, choose the one that best describes your role involving client access or facility ownership.
• Payment/Billing code (if applicable): If the notice shows that the agency will be billed, keep that with you for the appointment.

6) Read the privacy statement and applicant rights

• The form includes a summary of how your information will be used, who can receive results, and your rights to review and challenge records.
• Read it carefully. If anything is unclear, ask your agency contact before signing.

7) Sign the consent and authorization

• Sign and date the applicant authorization exactly as the form requires. Use blue or black ink if you are completing a paper copy.
• Some versions include a separate line to acknowledge you received and read the privacy statement. Initial where indicated.
• If the form has a space for the agency representative to sign, ensure your employer or licensing contact signs and dates their portion.

8) Schedule your fingerprint appointment

• The notice will include scheduling instructions. You will either book with an approved vendor or, if directed, obtain ink cards at a law enforcement office and mail them per the instructions.
• When booking, be ready to provide the service or request code shown on the notice and the Request ID/OCA so the vendor can tie your prints to the correct background check.
• Choose a location and time that meet your deadline. Sooner is better. Delays can stall your onboarding or license.

9) Prepare for your appointment

• Bring your government-issued photo ID and a copy of the notice with the request numbers.
• Bring payment if required. Some sites accept only certain payment methods. Check in advance.
• If your name recently changed, bring supporting documentation (for example, a marriage certificate or court order) along with your ID. Use your current legal name on the appointment and the form.

10) Complete the fingerprint capture

• Arrive early. The technician will verify your ID and capture your fingerprints electronically.
• After printing, you will receive a receipt with a transaction number. Keep it. If there is any routing issue, this number helps trace your prints to your request.
• If the vendor tells you a resubmission is needed due to unreadable prints, follow their instructions. Usually, a first reprint is free within a set window.

11) Record and submit required proof

• If the form has a section for “Date Fingerprinted” and “Transaction Number,” fill those in after your appointment.
• Provide a copy of your receipt to your employer or licensing contact if they request it. Keep the original for your records.

12) Monitor status and respond to requests

• Your employer or licensing office receives the results. Ask them how they plan to notify you.
• If results indicate a “review required,” you may be asked for certified court records, proof of compliance, or explanation statements. Respond quickly and completely to avoid delays.

13) Handle rejections or resubmissions

• If your fingerprints are rejected for quality, you will be instructed to resubmit. Schedule the reprint as soon as possible and bring your original receipt if the vendor needs it for billing.
• If multiple attempts fail due to unreadable prints, follow the instructions provided. The agency may allow a card submission or alternative process. Do not assume; wait for clear direction on the next step.

14) Keep copies and track expirations

• Keep a copy of the completed notice, your receipt, and any correspondence about your fingerprint check.
• Some roles require periodic rechecks. Ask your employer or licensing contact about renewal cycles and mark your calendar.

15) Avoid common errors that cause delays

• Do not leave the Request ID/OCA blank. That number links your prints to your case.
• Use your exact legal name and include all prior names. Missing an alias can slow processing.
• Do not miss the fingerprint deadline. If you can’t meet it, contact your employer or licensing contact immediately to discuss next steps.
• Write clearly if you complete a paper form. Illegible entries cause processing issues.

What the main sections typically include and how to handle them

• Parties: You (the applicant) and the requesting entity (employer, provider, or licensing agency). Make sure the agency name and contact are correct so results return to the right place.
• Clauses: Privacy, consent to obtain and share background information for eligibility, and your rights to review or challenge records. Read and acknowledge these sections before signing.
• Signatures: You sign and date the applicant authorization. The agency representative may sign and date their section to confirm the request and billing details.
• Schedules or attachments: A copy of your ID, any required disclosure statements, explanation pages if asked about prior history, and your fingerprint receipt. If you submit ink cards by mail as instructed, include any coversheet that came with your notice.

What happens after you submit fingerprints

• Processing and routing: Your prints are matched to state and national record repositories and routed back under the Request ID/OCA listed on your notice.
• Results to requester: The requesting entity receives your results. They determine your eligibility under the applicable rules and either clear you, request more information, or deny authorization.
• Your access to results: Ask your employer or licensing contact for a copy if you want to review it. If you believe something is wrong, request the procedure to challenge or correct the record.
• Work status: Until cleared, follow the supervision limits given to you. After clearance, your employer may lift restrictions and schedule you for regular duties.

Practical examples

• You’re hired as a long-term care worker. Your employer runs an initial check. You receive the DSHS 27-089 showing you must complete fingerprints within 14 days. You fill your name and prior names, confirm the provider information, sign the authorization, and book an appointment using the numbers on the notice. You bring your ID, get printed, and email the receipt to your HR contact. Four days later, your employer confirms clearance. You can now work unsupervised with clients. If your results had required review, you would have been asked for court documents and an explanation statement. During that review, you would have remained under supervision until a final decision.
• You are the new co-licensee for a facility. The licensing office sends you the notice and requires fingerprints before a final licensing decision. You complete the form, get printed, and return the appointment receipt. Your results arrive, showing no disqualifying history. The licensing office finalizes your approval. You set a reminder to redo the background check before the next renewal window.

If you follow the notice, complete the form carefully, and get fingerprinted promptly, you reduce delays and avoid interruptions to your work or licensing timeline.

Legal Terms You Might Encounter

• Authorization: This is your written consent that allows the state to run your fingerprint-based background check. The DSHS 27-089 form captures your permission so agencies can request and share results for this purpose.
• Background Check: This is a review of your criminal history and related records. The form tells you fingerprints will be used to match your identity against official databases.
• Fingerprint-Based: This means your fingerprints, not just your name and date of birth, confirm your identity. The form explains that fingerprints are required to reduce errors and missed records.
• Criminal History Record: This is the official record of arrests, charges, and dispositions. Your fingerprints link the search to the correct record, which the state will use for screening.
• Disqualifying Crime or Finding: This refers to offenses or administrative findings that may bar you from certain roles. The form gives notice that results may be used to determine whether you can work or volunteer in covered settings.
• Adverse Action: This is when an employer or agency denies, limits, or ends your role based on your background check. The form alerts you that results may affect your eligibility and that you may have rights to review or challenge them.
• Noncriminal Justice Purpose: Your fingerprints are collected for screening, licensing, or employment—not for a criminal investigation. The form describes this limited purpose so you understand how your data will be used.
• Secondary Dissemination: This means sharing your results with another authorized party. The form explains who may receive the report and under what conditions.
• Retention: This describes how long your fingerprints and results may be stored. The form explains that records may be kept as required for compliance and audits.
• Identity Verification: You must prove who you are during fingerprinting. The form warns that you must bring acceptable ID so your prints match your identity.
• Rap Back or Ongoing Monitoring: Some roles require notice of new arrests or changes after the initial check. The form may notify you if ongoing monitoring applies to your position.
• Reprint or Rejection: Sometimes fingerprints are too faint or incomplete. The form prepares you for the possibility that you might need to redo prints to complete the check.
• Privacy Notice: This explains what information is collected, why, how it is used, and your rights. The form provides this notice so you can make an informed choice before signing.

FAQs

Do you need to submit fingerprints for every background check?

Yes, if the notice requires fingerprint-based screening. Name-only checks are not a substitute. The form explains that fingerprints are mandatory for the scope described.

Do you need a Social Security number to complete the form?

Not always, but providing it helps match records. If you do not have one, follow the form’s instructions for alternate identification.

Do you have to pay a fee for fingerprinting?

You may. Fees vary by fingerprinting site and appointment type. The form does not process payment; you pay the fingerprinting provider if required.

Do you need to use a specific fingerprinting method?

You usually can choose live-scan (electronic) or ink if offered. The form accepts either method as long as the prints meet quality standards and are sent correctly.

Do you need an appointment for fingerprinting?

In most cases, yes. Walk-ins are limited and can lead to long waits. Schedule early so results arrive before your deadline.

Do you have to submit new fingerprints if you already did one recently?

Often, yes. Fingerprints are tied to a specific purpose and agency request. Reuse is limited unless the requesting agency allows it for the same purpose within a set period.

Do you get a copy of your background check results?

You may request one. The form explains your right to review and challenge inaccuracies. Ask the requesting agency how to receive or view your results.

Do you need to disclose sealed or juvenile records on the form?

Follow the form’s disclosure directions carefully. Even if you do not disclose certain items, fingerprint-based checks may still show related information. Answer truthfully as the form instructs.

Do you need to list every name you have ever used?

Yes. Include maiden names, prior married names, and aliases. Omitting a former name can delay processing or trigger reprints.

Do you need to notify anyone if your fingerprints are rejected?

Yes. Notify the requesting agency and reschedule as soon as you receive the rejection notice. Delays can pause hiring or licensing decisions.

Do you have to be physically present in Washington to complete fingerprinting?

Not always. You can often submit fingerprints from another state through approved channels. Check the form’s instructions for out-of-state options.

Do you need a specific type of identification at the fingerprint appointment?

Bring a current government-issued photo ID. If your name changed, bring proof of the change so your ID matches the information on the form.

Checklist: Before, During, and After the DSHS 27-089 – Fingerprint Based Background Check Notice

Before signing

• Confirm you are the person who must sign the notice.
• Read the entire notice and privacy disclosures.
• Gather full legal name, all prior names, and aliases.
• Collect complete address history requested on the form.
• Have your date of birth and place of birth ready.
• Note your driver’s license or state ID number.
• Have your Social Security number, if available.
• Get documents for name changes, if any.
• Confirm the requesting agency or program details.
• Verify the purpose of the background check.
• Check deadline and submission method.
• Identify your fingerprinting location options.
• Budget for fingerprinting fees, if any.
• Ask how to request a copy of the results.
• Plan transportation and time off for your appointment.

During signing

• Confirm your full legal name matches your ID exactly.
• List every former name and alias. Don’t skip any.
• Enter your date of birth correctly.
• Use your current physical address, not a P.O. Box.
• Verify your contact information is current.
• Review the privacy notice and use of fingerprints.
• Check the boxes for consents or disclosures as directed.
• Sign and date where required, in ink if on paper.
• If electronic, follow prompts to complete your e-signature.
• Make sure the requesting agency section is complete.
• Note any reference number for your appointment or packet.

At the fingerprinting appointment

• Bring a valid government-issued photo ID.
• Bring proof of name change if your ID does not match.
• Bring the form or instruction page if required.
• Verify your demographic details with the technician.
• Confirm the correct reason code or purpose is used.
• Make sure your prints are captured fully and clearly.
• Ask for confirmation or a receipt with a transaction number.
• Keep a copy of any barcode or appointment confirmation.

After signing and printing

• Submit the form as directed by the agency or employer.
• Do not send fingerprints directly unless instructed.
• Keep copies of the signed form and your receipt.
• Record the date you submitted the form and prints.
• Notify the requester that printing is complete.
• Track your status and expected timeline.
• Respond quickly to any request for reprints.
• Save the final clearance or result notice you receive.
• Store your documents securely for future reference.

Common Mistakes to Avoid DSHS 27-089 – Fingerprint Based Background Check Notice

Leaving out former names or aliases.

• Consequence: Delays, mismatches, or repeated prints. Don’t forget maiden or prior married names.

Using a nickname or shortened name.

• Consequence: Identity mismatch and processing errors. Use your full legal name exactly as on your ID.

Incorrect date of birth or address.

• Consequence: Record mismatches. Double-check every digit and spelling before you sign.

Missing signature or date.

• Consequence: The request is invalid and rejected. Sign and date all required fields.

Poor fingerprint quality.

• Consequence: Rejections and reprints. Hydrate, avoid lotions, and follow the technician’s guidance.

Scheduling too late.

• Consequence: Hiring or licensing delays. Book your appointment as soon as you sign the form.

Ignoring a reprint notice.

• Consequence: Your background check remains incomplete. Reschedule immediately and notify the requester.

Submitting to the wrong recipient.

• Consequence: Lost time and potential privacy risk. Follow the form’s submission route exactly.

What to Do After Filling Out the Form

Confirm submission method.

• Send the signed notice as instructed. If you submit electronically, verify it uploaded successfully. If mailing, use a traceable method when allowed.

Schedule fingerprinting.

• Book the first available appointment at an approved site. Keep your confirmation number and location details.

Prepare for the appointment.

• Bring acceptable ID and name-change documents. Review your information to ensure it matches your form.

Complete fingerprints and get proof.

• Request a receipt or transaction number from the technician. Keep it with your records until results are final.

Notify the requester.

• Tell the agency or employer that your fingerprints are complete. Provide your confirmation or transaction number if asked.

Monitor status and messages.

• Check your email, mail, and phone for updates. Respond immediately to requests for reprints or clarifications.

Handle reprints quickly.

• If your prints are rejected, reschedule at once. Confirm the reason for the rejection and adjust—clean hands, no lotions, more pressure if guided.

Request your results, if allowed.

• Ask how to obtain a copy for your records or review. Follow any outlined process to view or receive results.

Review accuracy.

• If something appears wrong, request a correction process. You may need to provide proof of identity or court records to resolve errors.

Manage adverse action notices.

• If a decision is based on your background check, you may receive a notice. Read it carefully and follow the steps to ask questions or submit clarifying information.

Update personal details if they change.

• If your address, phone, or name changes during processing, tell the requester to avoid missed notices.

Retain records.

• Keep your signed form, fingerprint receipt, and result notice in a secure place. You may need them for future renewals or audits.

Plan for renewals.

• Some roles require periodic rechecks. Mark your calendar for renewal dates so you have time to schedule fingerprinting again.

Limit further disclosure.

• Only share your results with parties who are authorized and need them. Keep copies secure to protect your privacy.