%PDF-1.6
%
1301 0 obj
<>/Metadata 1300 0 R/Names 1292 0 R/PageLabels<>1<
>2<>3<>]>>/Pages 486 0 R/Perms</Filter/Adobe.PPKLite/M(D:20141229162236-06'00')/Name(ARE Acrobat Product v8.0 P23 0002337)/Prop_Build<>/Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/StructTreeRoot 1 0 R/Type/Catalog>>
endobj
1293 0 obj
<>>>
endobj
1294 0 obj
<>/XObject<>>>/Fields[333 0 R 338 0 R 342 0 R 483 0 R 348 0 R 352 0 R 356 0 R 360 0 R 364 0 R 484 0 R 371 0 R 374 0 R 377 0 R 380 0 R 383 0 R 386 0 R 389 0 R 392 0 R 395 0 R 398 0 R 401 0 R 404 0 R 407 0 R 410 0 R 413 0 R 416 0 R 419 0 R 422 0 R 425 0 R 428 0 R 431 0 R 434 0 R 437 0 R 440 0 R 443 0 R 446 0 R 449 0 R 452 0 R 455 0 R 458 0 R 461 0 R 464 0 R 467 0 R 470 0 R 473 0 R 476 0 R 479 0 R 488 0 R 492 0 R 496 0 R 1147 0 R 505 0 R 509 0 R 513 0 R 517 0 R 520 0 R 1148 0 R 1149 0 R 1150 0 R 1151 0 R 1152 0 R 1153 0 R 1154 0 R 538 0 R 542 0 R 546 0 R 550 0 R 554 0 R 558 0 R 562 0 R 566 0 R 570 0 R 574 0 R 1155 0 R 580 0 R 584 0 R 588 0 R 592 0 R 596 0 R 600 0 R 604 0 R 608 0 R 1156 0 R 614 0 R 618 0 R 1157 0 R 624 0 R 628 0 R 1158 0 R 634 0 R 638 0 R 1159 0 R 644 0 R 648 0 R 652 0 R 656 0 R 660 0 R 664 0 R 668 0 R 672 0 R 676 0 R 1160 0 R 1161 0 R 1162 0 R 686 0 R 690 0 R 1163 0 R 696 0 R 700 0 R 704 0 R 1164 0 R 710 0 R 1165 0 R 716 0 R 1166 0 R 722 0 R 1167 0 R 1168 0 R 1169 0 R 1170 0 R 734 0 R 738 0 R 1171 0 R 744 0 R 1172 0 R 750 0 R 1173 0 R 756 0 R 1174 0 R 762 0 R 1175 0 R 1176 0 R 770 0 R 774 0 R 1177 0 R 1178 0 R 782 0 R 1179 0 R 788 0 R 792 0 R 1180 0 R 1181 0 R 800 0 R 1182 0 R 806 0 R 810 0 R 1183 0 R 1184 0 R 1185 0 R 1186 0 R 1187 0 R 1188 0 R 1189 0 R 1190 0 R 995 0 R 998 0 R 1001 0 R 1004 0 R 1007 0 R 1010 0 R 1013 0 R 1016 0 R 1019 0 R 1022 0 R 1025 0 R 1028 0 R 1031 0 R 1034 0 R 1037 0 R 1040 0 R 1043 0 R 1046 0 R 1049 0 R 1052 0 R 1055 0 R 1058 0 R 1061 0 R 1064 0 R 1067 0 R 1191 0 R 1192 0 R 1193 0 R 1194 0 R 1195 0 R 1196 0 R 1197 0 R 1198 0 R 1199 0 R 1134 0 R 1137 0 R 1140 0 R 1143 0 R 1202 0 R 1206 0 R 1210 0 R 1214 0 R 1218 0 R 1222 0 R 1226 0 R 1230 0 R 1234 0 R 1280 0 R 1240 0 R 1244 0 R 1248 0 R 1252 0 R 1256 0 R 1281 0 R 1262 0 R 1282 0 R 1283 0 R 1270 0 R 1274 0 R]/SigFlags 2>>
endobj
1300 0 obj
<>stream
application/pdf
iText 2.1.4 (by lowagie.com)
2014-12-29T16:21:19-06:00
2014-12-29T16:22:36-06:00
LiquidOffice Java Publishing Framework
2014-12-29T16:22:36-06:00
uuid:4c766b5c-3f04-48dd-a094-c975141f5e80
uuid:cf4f5a7b-ea13-43cc-9024-6ae3daa7138d
endstream
endobj
1292 0 obj
<>
endobj
486 0 obj
<>
endobj
1 0 obj
<>/Type/StructTreeRoot>>
endobj
1299 0 obj
<>
endobj
1295 0 obj
<>
endobj
1296 0 obj
<>
endobj
1297 0 obj
<>
endobj
1298 0 obj
<>
endobj
1050 0 obj
<>/P 90 0 R/S/Form/Type/StructElem>>
endobj
1053 0 obj
<>/P 91 0 R/S/Form/Type/StructElem>>
endobj
1056 0 obj
<>/P 88 0 R/S/Form/Type/StructElem>>
endobj
1059 0 obj
<>/P 92 0 R/S/Form/Type/StructElem>>
endobj
1062 0 obj
<>/P 93 0 R/S/Form/Type/StructElem>>
endobj
1065 0 obj
<>/P 89 0 R/S/Form/Type/StructElem>>
endobj
1068 0 obj
<>/P 94 0 R/S/Form/Type/StructElem>>
endobj
283 0 obj
<>/P 281 0 R/S/Private/Type/StructElem>>
endobj
287 0 obj
<>/P 285 0 R/S/Private/Type/StructElem>>
endobj
1085 0 obj
<>/P 281 0 R/S/Form/Type/StructElem>>
endobj
1089 0 obj
<>/P 285 0 R/S/Form/Type/StructElem>>
endobj
290 0 obj
<>/P 288 0 R/S/Private/Type/StructElem>>
endobj
293 0 obj
<>/P 291 0 R/S/Private/Type/StructElem>>
endobj
1099 0 obj
<>/P 288 0 R/S/Form/Type/StructElem>>
endobj
1103 0 obj
<>/P 291 0 R/S/Form/Type/StructElem>>
endobj
296 0 obj
<>/P 294 0 R/S/Private/Type/StructElem>>
endobj
299 0 obj
<>/P 297 0 R/S/Private/Type/StructElem>>
endobj
1113 0 obj
<>/P 294 0 R/S/Form/Type/StructElem>>
endobj
1117 0 obj
<>/P 297 0 R/S/Form/Type/StructElem>>
endobj
302 0 obj
<>/P 300 0 R/S/Private/Type/StructElem>>
endobj
305 0 obj
<>/P 303 0 R/S/Private/Type/StructElem>>
endobj
1127 0 obj
<>/P 300 0 R/S/Form/Type/StructElem>>
endobj
1131 0 obj
<>/P 303 0 R/S/Form/Type/StructElem>>
endobj
307 0 obj
<>/P 115 0 R/S/Private/Type/StructElem>>
endobj
1138 0 obj
<>/P 115 0 R/S/Form/Type/StructElem>>
endobj
309 0 obj
<>/P 117 0 R/S/Private/Type/StructElem>>
endobj
1144 0 obj
<>/P 117 0 R/S/Form/Type/StructElem>>
endobj
1275 0 obj
<>/P 311 0 R/S/Form/Type/StructElem>>
endobj
311 0 obj
<>
endobj
310 0 obj
<>
endobj
1201 0 obj
<>/Tabs/S/Type/Page>>
endobj
1279 0 obj
<>>>
endobj
1284 0 obj
<>stream
x+r
2P077QIr
-1'
endstream
endobj
1202 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[17.5 296.5 594.5 752]/StructParent 88/Subtype/Widget/T(Text14)/TU(Use this space to expand the explanations or information related to questions from page 3)/Type/Annot>>
endobj
1206 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[17.5 271.75 588.43 299.75]/StructParent 89/Subtype/Widget/T(Text10_1)/TU(I certify that all the information I have provided on this form is true and correct to the best of my knowledge. I certify that all statements on this form have been read by me or read to me and I understand all the questions.)/Type/Annot>>
endobj
1210 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[17.5 753.23 99.78 776.23]/StructParent 90/Subtype/Widget/T(Text2_13)/TU(SFN 838 \(12-2014\))/Type/Annot>>
endobj
1214 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[17.5 746.5 68.39 765.83]/StructParent 91/Subtype/Widget/T(SmartText1_2)/TU(Page 4 of 4)/Type/Annot>>
endobj
1218 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[22 98.65 180.78 126.91]/StructParent 92/Subtype/Widget/T(Text12_4)/TU(If Electronic Fingerprint Submission:)/Type/Annot>>
endobj
1222 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[22 60.4 180.78 88.66]/StructParent 93/Subtype/Widget/T(Text12_5)/TU(If Inked Fingerprint Submission:)/Type/Annot>>
endobj
1226 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[35.5 39.28 288.78 77]/StructParent 94/Subtype/Widget/T(Text12_6)/TU(Two Signed Copies to DHS Criminal Background Check Unit )/Type/Annot>>
endobj
1230 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[19.61 123.25 268.39 144.91]/StructParent 95/Subtype/Widget/T(Text19)/TU(DISTRIBUTION OF SFN 838)/Type/Annot>>
endobj
1234 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[35.5 70.33 387.78 117.5]/StructParent 96/Subtype/Widget/T(Text12_8)/TU(Scanner Operator: Scan SFN 838 \(pages 3 and 4 only\), submit to DHSCriminal Background Check Unit via Group EMail Address - dhscfscbc@nd.gov )/Type/Annot>>
endobj
1280 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[16.9 12.4 590.6 149.6]/Subtype/Widget/T(Rectangle4_1)/Type/Annot>>
endobj
1240 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[22 137.18 594.78 225.5]/StructParent 97/Subtype/Widget/T(Text9_3)/TU( YOUR RIGHTS AND RESPONSIBILITIESThe Privacy Act of 1974 \(P.L. 93-579, Section 7\) requires that the following information be provided when individuals are requested to disclose their social security number: Disclosure of the social security number is\
voluntary and is requested for the purpose of conducting a criminal history background check. Failure to disclose this information may affect the applicants ability to become a licensed foster parent; for employment at a foster care facility; for employ\
ment at a licensed child placing agency; to become an appointed legal guardian of children, to be approved for adoption; to become a licensed childcare provider, a holder of a self declaration or in-home registration document or to become a staff member w\
ith an early childhood services program. )/Type/Annot>>
endobj
1244 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[19.75 194.43 41.77 227.75]/StructParent 98/Subtype/Widget/T(Text20_2)/TU(*)/Type/Annot>>
endobj
1248 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[71.5 13 248.28 63.5]/StructParent 99/Subtype/Widget/T(Text15)/TU(Children and Family Services-CBCUNorth Dakota Dept. of Human Services600 E Boulevard Ave Dept 325Bismarck ND 58505-0250)/Type/Annot>>
endobj
1252 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[35.5 35.5 99.78 63.5]/StructParent 100/Subtype/Widget/T(Text15_3)/TU(Mail to:)/Type/Annot>>
endobj
1256 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[20.89 245.92 122.28 265.25]/StructParent 101/Subtype/Widget/T(TX_27)/TU( Signature of Applicant:)/Type/Annot>>
endobj
1281 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[107.25 247.16 410.25 257.66]/Subtype/Widget/T(Line5_2)/Type/Annot>>
endobj
1262 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[409 245.92 437.79 265.25]/StructParent 102/Subtype/Widget/T(TX_28)/TU(Date:)/Type/Annot>>
endobj
1282 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[431.25 247.16 590.25 257.66]/Subtype/Widget/T(Line5_3)/Type/Annot>>
endobj
1283 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[16.9 223.9 595.1 280.51]/Subtype/Widget/T(Rectangle1_39)/Type/Annot>>
endobj
1270 0 obj
<>/BS<>/DA(/Helv 0 Tf 0 g )/DR<>/XObject<>>>/F 4/FT/Btn/Ff 65537/MK<>/TP 1>>/Rect[22 224.5 594.78 255.16]/StructParent 103/Subtype/Widget/T(Text22_1)/TU(SFN 838 must be received in CBCU within 10 working days from date signed by applicant. \(Note: Applicant may need to re-sign/re-date SFN 838 to fulfill this requirement\) )/Type/Annot>>
endobj
1274 0 obj
<>/F<>/Fo<>/K<>/V<>>>/AP<>/BS<>/DA(/ArialMT 10 Tf 0 0 0 rg )/DR<>>>/F 4/FT/Tx/Ff 8392704/Rect[27 310.5 585 730.84]/StructParent 219/Subtype/Widget/T(Explain)/TU(Explain)/Type/Annot>>
endobj
66 0 obj
<>
endobj
1287 0 obj
<>
endobj
1276 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form/Type/XObject>>stream
xPpuVpb
endstream
endobj
1273 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH347QpW }
endstream
endobj
331 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form/Type/XObject>>stream
xUNN0+ޱ=kunlb8t[M)Sd~D!PjU"\Ay±"4bP@7Jkh+ޣEV}"C'f ek翍kp*,@MQϭJ@@㼀-G8bzXj1.=ڴ-XGogY~2O\8ĈxT
endstream
endobj
337 0 obj
<>
endobj
1272 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Subtype/Form/Type/XObject>>stream
x+T0BS3=s#3=33Tp<} _|@ ,
endstream
endobj
1269 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH347VpW |
endstream
endobj
330 0 obj
<>/Subtype/Form/Type/XObject>>stream
x3T0 BCS=3]UegPeeehke Vd*Y 9\fL|\eW0W S
endstream
endobj
1268 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Subtype/Form/Type/XObject>>stream
x+T0BSs= igfP
endstream
endobj
1267 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH347RpW
{
endstream
endobj
329 0 obj
<>/Subtype/Form/Type/XObject>>stream
x3T0 BCS=#S]0UegnbalPeeehke ehbg`h $r`FW0W
endstream
endobj
1266 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Subtype/Form/Type/XObject>>stream
x+T0BCSS3=STp<} _|@ mL
endstream
endobj
1265 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH347TpW z
endstream
endobj
328 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form/Type/XObject>>stream
x3T0 BC]K]#S=K#\B.C\<BBD:BH#=sS\.
ĒT+͐,.. <
endstream
endobj
1264 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Subtype/Form/Type/XObject>>stream
x+T0A=sKCS=c#Tp<} _|@
endstream
endobj
1261 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH347PpW y
endstream
endobj
327 0 obj
<>/Subtype/Form/Type/XObject>>stream
x3T0 BCS=#S]0UegnbalPeeehke edig`h $r`FW0W
endstream
endobj
1260 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Subtype/Form/Type/XObject>>stream
x+T0AKK3=STp<} _|@ n!'
endstream
endobj
1259 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH34TpW *
endstream
endobj
326 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form/Type/XObject>>stream
x3T0 BC]#=K ebgiUe32Ie)@!$Hs+X(ah137UPLK,)-JUOS45p,(LN+Ҍ
r
endstream
endobj
1258 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Subtype/Form/Type/XObject>>stream
x+T0BKs=CS=c#Tp<} _|@
endstream
endobj
1255 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH34PpW %
endstream
endobj
325 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form/Type/XObject>>stream
x3T0 BC]cS=S(Ue01 p :p($t.}7c4T
!\9
%V!Y\!\ q~/
endstream
endobj
1254 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Subtype/Form/Type/XObject>>stream
x+T0B3=##Tp<} _|@ swN
endstream
endobj
1251 0 obj
<>>>/Subtype/Form/Type/XObject>>stream
xӏH343WpW
endstream
endobj
324 0 obj
<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Subtype/Form/Type/XObject>>stream
xe=o0w!BIBHwĔ8iM_!:=wK Ҳ&lS>W*}D
uI@Y䧺i
+m{ㆺ4(P}In;ןPsk滏Zݾ&R;L9Ywm̠](X"
sL(