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INSTRUCTIONS: ARIZONA REGISTRATION AND EMPLOYMENT HISTORY FOR PROVIDING DES-CERTIFIED CHILD CARE SERVICES (Form CC-201A)

When a person is hired to provide child care services in Arizona, they are required to complete a form CC-201A. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 1: In the first blank box, enter the date.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 2: Indicate with a check mark whether you are an applicant, a household member, or filing a back-up copy.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 3: In the second blank box, enter the name of the person being fingerprinted.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 4: In the third blank box, enter the Social Security number of the person being fingerprinted.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 5: In the fourth blank box, enter the occupation of the person being fingerprinted. 

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 6: If the child care provider's name is different from the above, enter it in the fifth blank box.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 7: In the next section, detail your employment history for the last five years by giving each employer's name, address and phone number, as well as your job title, employment dates and reason for leaving. Attach additional sheets if you need more space to document your employment history for the last five years.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 8: Indicate with a check mark whether or not you give DES permission to contact the listed employers. If not explain why.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 9: Indicate with a check mark whether you have ever been employed to work with children. If yes, list the applicable employer's name and address.

Arizona Registration And Employment History For Providing DES-Certified Child Care Services CC-201A Step 10: Answer all remaining questions and detail your household composition as instructed.