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Click ‘Get Form’ to open the Health Care Worker Background Check in our editor.
Begin by filling in your personal information. Enter your First Name, Full Middle Name, and Last Name in the designated fields.
Provide your Mailing Address, City, and Zip Code. Ensure that all details are accurate for proper identification.
Complete the demographic section by selecting your Race, Gender, and entering your Date of Birth. This information is crucial for identification purposes.
Fill in your Social Security Number as required by law. Remember that a facsimile or photographic copy of this authorization will be valid.
Answer the questions regarding any administrative findings of Abuse, Neglect, or Theft, and any criminal offenses. Provide full details if applicable.
Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2021	4.9 Satisfied (25 Votes)
2020	4.6 Satisfied (55 Votes)
2015	4.8 Satisfied (161 Votes)
2013	4 Satisfied (37 Votes)
2011	4.8 Satisfied (28 Votes)
2007	4.2 Satisfied (55 Votes)

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What is a health care background check?

All healthcare providers are required to conduct background checks for healthcare employees. Most often these consist of state-mandated professional credential verification, and checks against criminal record databases and sex offender registries.

What can disqualify you from working in healthcare?

The California Board of Registered Nursing reviews criminal convictions on a case-by-case basis. However, sex offenses, violent crimes, failing to follow reporting requirements, and fraud may prevent a candidate from working as a nurse in the state.

What will stop you from passing a background check?

How Far Back Do Criminal Background Checks for Healthcare Workers Go? The most common increment of time that background checks go back to is a period of seven years.

What will disqualify you on a background check?

For example, some candidates may have a failed background check because of their credit history, and others may fail because of a criminal conviction, suspended drivers license, or positive drug test.

How far back do healthcare background checks go?

How far back do hospitals do background checks? The lookback period for background checks varies from state to state. In some states, hospitals may only be able to see 7 to 10 years of criminal history. In other states, background checks report all convictions, regardless of how long ago they occurred.

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