N.H. Code Admin. R. He-C 6447.10
(c) DCYF may, in lieu of the fingerprint-based criminal history record check, accept police clearances from every city, town, or county where the individual has lived during the preceding 5 years, in limited specific circumstances if:
(e) Each applicant shall submit a completed Form 1717 “Local Law Enforcement Check” (September 2025) authorizing the licensing agency to receive all relevant information and records from local law enforcement agencies for the applicant and all adult household members certifying:
“I/We agree to provide any further information, as requested, in reference to my/our past record. I/We also authorize and request every person, firm, company, corporation, governmental agency, court, association or institution having control of any documents, records, or other information pertaining to me/us, to provide to the Division for Children, Youth and Families (DCYF), its agents, or oher Child-Placing Agency, any such information including documents, records, or files regarding charges or complaints filed against me/us, formal or informal, pending or closed, and other pertinent data; and I/we further authorize and request to permit the DCYF or any of its agents to inspect and make copies of such records.
I/We hereby release, discharge, and exonerate the Division for Children, Youth and Families (DCYF), its agents and representatives, and any persons so furnishing or inspecting such documents, records, or other information for the investigation made by or on behalf of DCYF.
I/We hereby agree to the release of information to the Division for Children, Youth and Families, its agents and representatives.”
Source. #14390, eff 9-24-25, EXPIRES: 9-24-35