DO NOT WRITE BELOW THIS LINE
HIRED: YES NO POSITION
DEPT. SALARY/WAGE
DATE REPORTING TO WORK SHIFT
REFERENCE CHECKS
LICENSE VERIFICATION STNA
RN
LPN
ADM/SOCIAL
Revised 10/1/01
WHY DO I HAVE TO
GET FINGERPRINTED?
When you apply for this job, you have to get fingerprinted and sign a form. WE AREN'T DOING THIS BECAUSE WE DON'T TRUST YOU OR DON'T WANT YOU TO COME TO WORK FOR US. WE'RE DOING IT BECAUSE WE HAVE TO UNDER STATE LAW.
A state law says people who work with the elderly have to be checked to see if they have a criminal record. This is true even if you don't have a record. The law was passed to protect elderly people (and people who work with them) from convicted criminals.
The law also says you have to get fingerprinted. This is how the state checks to see whether you have a record. We apologize for the inconvenience and appreciate your interest in working with us!
LONG TERM CARE WORKER BACKGROUND CHECK
OHIO REVISED CODE SECTION 3722. 151
CONSENT AND ATTESTATION FORM
By signing this form, I consent to the submission of a request for a criminal records check for long term care workers as required by Ohio Revised Code section 3722. 151. The request will be submitted by Rose Garden.
I a |
