Written Authorization to Request a CAPS Check

A check of the Colorado Adult Protective Services (APS) data system (CAPS) is required for you (individual) because you are:
  • A potential employee/contractor who will provide direct care to at-risk adults.
An employer may also request a CAPS check for you if you provide direct care to an at-risk adult and you:
  • Were hired/contracted prior to the CAPS check requirement (1/1/2019), or
  • Are a volunteer, or
  • Will provide services to a CDASS recipient
The CAPS check will alert the employer (agency) whether you have or have not be substantiated in an APS case of mistreating an at-risk adult, to include physical abuse, sexual abuse, caretaker neglect, exploitation, and/or harmful act.
More information on the CAPS check requirement can be found in Colorado Revised Statute (26-3.1-111, C.R.S.) and in the Colorado Code of Regulations (12 CCR 2518-01).
Written authorization is required from the individual being checked, using this form. Please complete this form in its entirety. Knowingly providing inaccurate information on a CAPS check request is a class 1 misdemeanor pursuant to 18-1.3-501, C.R.S.

Agency Name: Craft Health
Agency Address: 1650 38th Street, Suite 101E, Boulder, CO 80301

Individual's Information

You must provide at least one (1) personal phone number and one (1) email address.

All individuals are required to provide five (5) years of residential history, regardless of whether in the U.S. or abroad. If you lived outside of the US in the past five (5) years, provide the international address(es), including the name of the city and country. If you have lived at your current address less than 5 years, please list your previous addresses for the past five years. Use another sheet of paper if necessary.

Previous Address 1

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