TE_3_-_Attch_1._IMCOM_Worksheet_30A_v._15_Mar_19_(FM).pdf

Work Order Ticket Checklist for Functional Managers (CSSC/Non-CSSC Sites)-Initial Checks for Non-employees

Personnel Category: Military, Contractors (Regular/Recurring), Specified Volunteers, Contractors (short duration) and Other Categories of Individuals

Applicant's Name

Garrison Name Functional Manager

Submit the following documents to your CDE Office in the following order via encrypted e-mail:

REQUIRED FOR ALL

MILITARY

Additional Requirements

Summary of Child Services Duties

IMCOM 29 - Residency Information Worksheet *Note: Replaces OFI-86C

CONTRACTORS

(Regular/Recurring) Additional Requirements

Position Description

Resume/Application

Reference Check(s)- Only submit if reference is derogatory

Proof of Citizenship Documents (See IMCOM 31)

OF 306

IMCOM 29 - Residency Information Worksheet *Note: Replaces OFI-86C

SPECIFIED

VOLUNTEERS,

CONTRACTORS (Short Duration) and

OTHER CATEGORIES

OF INDIVIDUALS

Additional Requirements

Position Description

Resume/Application

IMCOM Worksheet 30A (v 15 Mar 2019) page 1

IMCOM Worksheet 30A

IMCOM Form 30

DA Release/Consent Form

DA Form 5018-R

DD 2981 (Upon Release of EXORD)

Reference Check(s)- Only submit if reference is derogatory IMCOM 28 - Fingerprint Information Worksheet (signed)

Provider's Name:

Household Member's Name:

Garrison Name: Functional Manager

Submit the following documents to your CDE Office in the following order via encrypted e-mail:

REQUIRED FOR ALL

FCC/IHCP

Additional Requirements

Position Description

Application/Resume: FCC/Backup-5219 required. Other IHCP-Any

Reference Check(s)- Only submit if reference is derogatory

OF 306

IMCOM 29 - Residency Information Worksheet *Note: Replaces OFI-86C

INDIVIDUALS RESIDING IN

FCC HOMES

Additional Requirements

Reference Check(s)- Only submit if reference is derogatory

IMCOM Form 30: Only required if request is submitted separately from IHCP Household

IMCOM Worksheet 30A (v15 Mar 2019) page 2

Work Order Ticket Checklist for Functional Managers (CSSC/Non-CSSC Sites)-Initial Checks for In Home Care Provider Personnel Category: Family Child Care (FCC)- IHCP, Respite Care-IHCP, Emergency Placement Care (EPC)- IHCP and Household Members (FCC, EPC)

NOTE: A separate IMCOM 30A will be completed for each individual residing in the home. Emergency Placement Care (EPC), requires both parents to be a provider.

IMCOM Worksheet 30A

IMCOM Form 30

DA Release/Consent Form

DA Form 5018-R

DD 2981 (Upon Release of EXORD)

Proof of Citizenship Documents (See IMCOM 31)

Work Order Ticket Checklist for Functional Managers (CSSC/Non-CSSC Sites)-Reverification for Non-Employees

Individual or IHCP's Name

IHCP Household Member's Name (if applicable)

Garrison Name

Personnel Category Specified Volunteer

Contractor (Regular/Recurring)

Military

In Home Care Provider

Individual's Residing in IHCP Home ages 12-17

Other Contractor (Short Duration)

Other Category of Individual

Submit the following documents to your CDE Office in the following order via encrypted e-mail:

REQUIRED FOR ALL

IMCOM Worksheet 30A

IMCOM Form 30 (For IHCP: 1 per Household)

DA Release/Consent Form (Unless already on file)

DA Form 5018-R

MILITARY/CONTRACTORS

(Regular/Recurring) Additional Requirements

IMCOM 29 - Residency Information Worksheet *Note: Replaces OFI-86C

SPECIFIED VOLUNTEERS,

CONTRACTORS (Short Duration) and OTHERS Additional Requirements

IMCOM 28 - Fingerprint Information Worksheet (signed)

IMCOM Worksheet 30A (v15 Mar 2019) page 3

NOTE: If this is your first time submitting a WOT through the CDE Office, the following legacy documents must be provided (as applicable): Position Description/Summary of Child Services Duties, Resume/Application, OF 306

(original), Previous PRB Documents (CRESR Printout, Tab A, Tab C, Tab I, 26A, 26B, Other PRB paperwork approved by GC (Tab K)).

Individual's Residing in IHCP Home age 18+

NOTE: A separate IMCOM 30A will be completed for each individual residing in the home.

EPC requires both parents to be providers.

Functional Manager

DD 2981 (Upon Release of EXORD)