New Mexico Children Youth & Families Department
Protective Services Division/Placement, Prevention & Adoption Resource Bureau/Criminal
Records Check Unit
CYFD Resource Family CRC Application
*Form shall be typed. Form will be rejected if information is missing. *
CYFD Field Offices must scan and e-mail the following to CYFD.PSCriminalReco@state.nm.us:
1. This CRC Application; and
2. Fingerpring Submission Receipt
not registration receipt
**
Please scan all required documents together as one pdf document. E-mail subject line shall include applicant's Last Name
(only)
and FACTS Provider ID
#. Any questions shall be directed to the CRC Unit at (505) 827-8400 or by e-mail to: CYFD.PSCriminalReco.@state.nm.us.**
CYFD Field Office Contact Information
*Registration ID#:
you will receive this ID# after you have completed Step #2 registering your applicant to be fingerprinted.
updated 10.08.2020
*Application Type:
*Phone #:
, NM
*Zip:
Applicant Information
*First Name
*Middle Name
If none then put NMN
*Last Name
*Aliases/AKA/Madien Name, Jr., Sr., nick name(s) etc.
If none then put N/A
*Social Security Number
9 digits
*Date of Birth
mm/dd/yyyy
*Drivers License Information
State
DL#
*Physical Address
Include apartment /unit # if applicable
*City
, NM
*Zip Code
*Citizenship
*Race
*Height *Weight
*Phone #
*Eye Color
drop down box
*Hair Color
drop down box
*Sex Female
Male
*City:
*FACTS Provider ID#:
*Contact Person:
*County:
*Mailing Address:
*E-mail:
*Member Type:
*FACTS Case #:
Date Child(ren) Placed
applicable if provisional
:
Fingerprint Registration Information
*Supervisor:
REMINDERS:
> If this is a Provisional Applicant, please use and submit this application, with the subject line: "Provisional."
> If this background check needs to be expediated, please have your supervisor e-mail as to reasons whay and when it is needed by.
> If you have questions or need the status of a background check, please e-mail: CYFD.PSCriminalReco@state.nm.us. We will
need the applicants Name, DOB, Provider # and date fingerprinted. The E-mail subject line shouuld be: "Status" or "Question."
Choose the following ORI when registering applicants:
*Place of Birth
City, State
