OCFS-6005 - Criminal Conviction Statement-Child Day Care Programs

OCFS-6005 — Criminal Conviction Statement (New York State Child Day Care Programs)

The OCFS-6005 Criminal Conviction Statement is an official New York State form required for individuals involved in child day care programs. It is used to verify whether an applicant, employee, volunteer, or household member aged 18 or older has been convicted of a crime, ensuring compliance with state safety regulations. The form is mandatory for those applying for licensure or registration with the New York State Office of Children and Family Services (OCFS).

This fillable and printable form allows programs to document criminal history disclosures clearly and accurately. Applicants must provide identifying information, including their full name and date of birth, and indicate whether they have or have not been convicted of a misdemeanor or felony in New York or any other jurisdiction. The form includes a certification section that must be signed and dated, confirming the truthfulness of the information under penalty of possible license denial, suspension, or employment consequences.

The OCFS-6005 is typically completed during the onboarding or application process for child care providers. It helps programs maintain compliance with state background screening requirements and ensures a safe environment for children. Although users may download the form as a PDF or DOCX template, it must be printed, signed, and retained as part of the official program record.

This document serves as an essential component of New York’s child care licensing procedures, supporting transparency and helping organizations meet regulatory standards. By completing the form accurately, applicants contribute to safeguarding the integrity and safety of child day care services across the state.