INSTRUCTIONS: ARIZONA CERTIFIED FAMILY CHILD CARE PROVIDER APPLICATION (Form CC-200-FF)

To apply for a position as an Arizona certified family child care provider, a form CC-200-FF should be completed. This document can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 1: Enter your full legal name in the first blank box.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 2: Enter your phone number, including the area code, in the third blank box. The second blank box is for departmental use only.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 3: Enter your Social Security number in the fourth blank box.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 4: Enter your birth date in the fifth blank box.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 5: Enter your full residential address in the sixth blank box.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 6: Enter your mailing address, if different from above, in the seventh blank box.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 7: Enter your email address in the eighth blank box.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 8: Enter directions to your home in the ninth blank box.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 9: Indicate whether your preferred language is English or Spanish with a check mark.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 10: Voluntarily indicate your race and ethnic background if you wish to.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 11: Indicate whether you are a U.S. citizen, eligible to work in the U.S. and whether you are an enrolled member of an American Indian tribe. If yes, write your tribe.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 12: On the remainder of the first page, document your previous marriages, household members, and adult and minor children out-of-home as instructed.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 13: On the second page, provide references as instructed, as wel as information about your housing and back-up child care provider.

Arizona Certified Family Child Care Provider Application CC-200-FF Step 14: Sign and date the bottom of the second page.