Healthcare Criminal History Background Affidavit - Mississippi State ... - msdh ms 2025

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  1. Click ‘Get Form’ to open the Healthcare Criminal History Background Affidavit in the editor.
  2. Begin by filling in the County and State at the top of the form. This information is essential for identifying the jurisdiction.
  3. In the section where it asks for your name, enter your full name as the affiant. Ensure accuracy as this will be used for verification.
  4. Next, indicate your current employer's name, which must be a licensed facility or entity recognized by the Mississippi State Department of Health.
  5. Carefully read through each statement regarding criminal history. Confirm that you meet all criteria and check any applicable boxes if required.
  6. Sign and print your name at the bottom of the affidavit. This signature confirms that you have sworn to the truthfulness of your statements.
  7. Finally, ensure that a Notary Public signs and dates the document to validate it officially.

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The cost is $50 per applicant background check. This includes both a state and national check.
The Letter of Suitability for Employment issued by the Mississippi State Department of Health verifies that a criminal records check, sex offender registry, and child abuse central registry check has been conducted on an individual.
NOTE: All background checks may take up to 30 days to be completed.
Maryland Seven-Year Rule for Reporting Conviction Records Under Md. Code Ann. 14-1203, CRAs may not report bankruptcies older than 10 years. They also cannot report civil judgments, civil lawsuits, paid tax liens, arrests, or convictions that are older than seven years.
State Regulations StateBackground Check Requirements Mississippi Seven years unless the salary is $75,000 or more Missouri No specific state limitations beyond FCRA Montana No specific state limitations beyond FCRA Nebraska Seven years47 more rows
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