MADISONVILLE COMMUNITY COLLEGE Nursing Division Student Background Policy and Procedure

Size: px
Start display at page:

Download "MADISONVILLE COMMUNITY COLLEGE Nursing Division Student Background Policy and Procedure"

Transcription

1 MADISONVILLE COMMUNITY COLLEGE Nursing Division Student Background Policy and Procedure Purpose Madisonville Community College s (MCC) Nursing Division requires students to complete background checks and drug screening. It is the policy of MCC to review charges brought against students and to take such action deemed appropriate for the protection of fellow students, employees, patients, and families of patients of clinical facilities. Background checks on Integrated Nursing Program students and Nurse Aid students are required for many reasons including but not limited to: 1. To enhance the safety and well-being of patients/residents and, in so doing, to support the public s continuing trust in the nursing profession; 2. To ascertain the ability of students to eventually become licensed nurses or maintain current licensure; 3. To prevent potential liability issues which may affect the MCC Nursing Division and affiliated clinical facilities; and 4. To comply with mandatory requirements of clinical agencies utilized by the Nursing Division. Applicability The Nursing Division will require background checks and drug screenings to be performed when enrolled in NAA 100 (Nurse Aide class) and when admitted to the Integrated Nursing Program (NIP) by a vendor approved by the program. The only exception will be if a student has recently completed the NAA 100 course. The schedule for completion of background checks and drug screenings will then be as follows: Semester NAA 100 Taken and Preliminary Screenings Conducted Spring semester (Full semester or a biterm) Summer semester Fall semester First bi-term Fall semester Full semester or second bi-term Students who enter NIP who did not take NAA 100 Readmit Students Admission Date August of same January of next January of next August of next January or August upon admission January or August upon readmission Date of Next Screenings January of next August of next August of next August of next Yearly Yearly

2 Semester NAA 100 Taken and Preliminary Screenings Conducted LPN entry Admission Date January or August upon admission Date of Next Screenings Yearly Policy Statement All students must complete and submit a background check and drug screening through the approved vendor as a condition of continued enrollment as a NAA100 student or a NIP student. Failure to do so will result in mandatory withdrawal of the student from the NAA or nursing course. Continued enrollment in NAA100 or NIP courses is contingent upon a completed background check and drug screening. The student will be required to withdraw for failure to consent to a background check and drug screening; refusal to provide necessary information to conduct a background check; falsifying information; failure to provide any additional information wherein an investigation is warranted; failure to report a misdemeanor and/or felony conviction occurring in Kentucky or any other state while enrolled in NAA or NIP courses; and failure to comply with the investigatory procedures when a cause for further action is warranted due to the: 1. Discovery of previously undisclosed information; 2. Discovery of conflicting information between or among the NIP application and/or the Background Check Report (CBCR) and/or any and all documents considered part of a student s application; or 3. Discovery of a charge or conviction while enrolled in NAA or NIP courses. Trafficrelated misdemeanor(s) do not have to be reported, with the exception of operating a motor vehicle under the influence of drugs or alcohol. 4. It is the responsibility of any student enrolled in the nursing program or a nurse aide class to report any charges, other than minor traffic offenses, brought against them to nursing administration. This should be reported on the application for admission and then throughout the program. Any student failing to report such charges brought against them is subject to termination from the nursing program or nurse aide class. The student must report to nursing administration within 5 working days of the charge being issued. 5. If the charge against the student is related to substance abuse or the use of illegal substances, the student must also submit to a new drug screening through the approved vendor within the time frame allotted by nursing administration. KRS Chapter (21) defines a conviction as the following: a) An unvacated adjudication of guilt; b) Pleading no contest or nolo contender or entering an Alford plea; or c) Entering a guilty plea pursuant to a pretrial diversion order; Regardless of whether the penalty is rebated, suspended, or probated. Procedure for Review of Background Check and Drug Screen Findings: 1. The Preliminary Review Committee (PRC) will consist of the following: a. Nurse Administrator/Program Coordinator

3 b. Nursing Division Chair c. NAA Coordinator d. Appointed Faculty Representative e. Human Resources Representative from the associated clinical facility (only for adverse findings on CBCR report) 2. Upon receipt of a CBCR and drug screen from the approved vendor that shows adverse findings, the PRC will review the report. 3. The PRC will meet to determine if the student is eligible to attend clinical experiences. Adverse findings include but are not limited to: a. Arrests for / Abuses of controlled substances, prescription medications, illegal substances, or alcohol; b. Conviction of any felony, or a misdemeanor involving drugs, alcohol, fraud, deceit, falsification of records, a breach of trust, physical harm or endangerment to others (i.e. assault), or dishonesty, under the laws of any state or of the United States; c. Conviction of a misdemeanor offense under KRS Chapter 510 involving a patient, or a felony offense under KRS Chapter (1)(a), or , or has been found to have had sexual contact as defined in KRS (7) with a patient; or d. Listed on the nurse aide abuse registry with a substantiated finding of abuse, neglect, or misappropriation of property. e. Positive urine drug screen. 4. If the PRC finds the student ineligible to attend clinical experiences, the student will be notified in writing by the Nurse Administrator. 5. The student will have five (5) days to submit an appeal to the Nurse Administrator following notification of the decision of the PRC regarding continued enrollment in the nursing program. 6. The student should contact the approved vendor if the student feels a background check report and/or drug screen is incomplete or inaccurate, by following the Summary of Your Rights Under the Fair Credit Reporting Act (Appendix A). 7. If the CBCR and/or drug screen is not cleared prior to the first clinical day, the student will be required to withdraw from the nursing course. CBCRC Documentation 1. The student s file will be retained. 2. The CBC and CBCRC investigation records will be stored in a locked, limited access file cabinet in the Nursing Division Chair s office suite. 3. The file will be shredded at the appropriate time or whenever the student has successfully completed the AAS degree from MCC. If you need additional information about the expungement process, an Expungement Guidebook is available in the Nursing Office. A Summary of Your Rights Under the Fair Credit Reporting Act

4 The Federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your file disclosure ). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: a person has taken adverse action against you because of information in your credit report; you are the victim of identify theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information. You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

5 Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to You may limit prescreened offers of credit and insurance you get based on information in your credit report. Unsolicited prescreened offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit Written April 2015 Revised November 2015

6

Police may conduct these checks. The following is a summary of various methods used for background checks and the requirements for each.

Police may conduct these checks. The following is a summary of various methods used for background checks and the requirements for each. Criminal Background Check and Security Check Policy for Nursing Facility Management in Louisiana Introduction All of our facilities are committed to the health, safety, and welfare of our residents. Part

More information

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA): Florida Certified Nursing Assistant Examination Application *APPCNAFL* Instructions: Please go to www.prometric.com/nurseaide/fl to print the current version of this application and all other forms. DO

More information

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA):

If applying for Testing Accommodations under the Americans with Disabilities Act (ADA): Florida Certified Nursing Assistant Examination Application *APPCNAFL* Instructions: Please go to www.prometric.com/nurseaide/fl to print the current version of this application and all other forms. DO

More information

BACKGROUND VERIFICATION INSTRUCTIONS

BACKGROUND VERIFICATION INSTRUCTIONS BACKGROUND VERIFICATION INSTRUCTIONS Policy 001-2014 NASAR policy requires background verifications for participation in certain positions and to comply with the National Child Protection Act. Due to your

More information

Adult Application Packet

Adult Application Packet Kaiser Permanente San Diego Member Service Area Volunteer Guest Services Department Adult Application Packet What you need to know before you apply Thank you for your interest in volunteering with Kaiser

More information

MISSOURI. Downloaded January 2011

MISSOURI. Downloaded January 2011 MISSOURI Downloaded January 2011 19 CSR 30-81.010 General Certification Requirements PURPOSE: This rule sets forth application procedures and general certification requirements for nursing facilities certified

More information

ADULT APPLICATION PACKET

ADULT APPLICATION PACKET Kaiser Permanente San Diego Member Service Area Volunteer Guest Services Department ADULT APPLICATION PACKET WHAT YOU NEED TO KNOW BEFORE YOU APPLY Thank you for your interest in volunteering with Kaiser

More information

RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING CHAPTER 4

RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING CHAPTER 4 RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING CHAPTER 4 AS AMENDED 2015 The RULES AND REGULATIONS OF THE MAINE STATE BOARD OF NURSING are adopted and amended as authorized by Title 32, Maine

More information

This is a Legal Document. By completing and signing, this you certify under

This is a Legal Document. By completing and signing, this you certify under APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION BY ENDORSEMENT, DEEMING, or RECERTIFICATION All certificates expire December 31 of every EVEN year This is a Legal Document. By completing and signing,

More information

Sign and return included forms. (Background Check Form, Authorization to Release Information Form, and Vehicle Use Agreement)

Sign and return included forms. (Background Check Form, Authorization to Release Information Form, and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

This is a Legal Document. By completing and signing this you certify under

This is a Legal Document. By completing and signing this you certify under APPLICATION FOR WYOMING LICENSED PRACTICAL NURSE (LPN) LICENSURE BY ENDORSEMENT *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this you certify

More information

Policy S-2 FLORIDA STATE UNIVERSITY COLLEGE OF NURSING Page 1 of 2 TITLE: CRIMINAL BACKGROUND CHECK

Policy S-2 FLORIDA STATE UNIVERSITY COLLEGE OF NURSING Page 1 of 2 TITLE: CRIMINAL BACKGROUND CHECK Policy S-2 FLORIDA STATE UNIVERSITY COLLEGE OF NURSING Page 1 of 2 TITLE: POLICY: CRIMINAL BACKGROUND CHECK The College of Nursing requires all students to have a Criminal Background Check on file at the

More information

NURSING REVIEW BOARD

NURSING REVIEW BOARD NURSING REVIEW BOARD I. Introduction The following procedure outlines the process to be followed in all cases where criminal findings are found in the background checks for prospective and current Nursing

More information

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training State of Florida Department of Health Board of Osteopathic Medicine Application for Registration as an Osteopathic Physician in Training Board of Osteopathic Medicine 4052 Bald Cypress Way, #C-06 Tallahassee,

More information

Home help services cannot be paid to: A minor (17 and under). Fiscal Intermediary (FI).

Home help services cannot be paid to: A minor (17 and under). Fiscal Intermediary (FI). ASM 135 1 of 13 HOME HELP PROVIDERS INTRODUCTION The items in this section may apply to both individual and agency providers. For additional policy and procedures regarding home help agency providers see

More information

Rutherford Co. Rescue

Rutherford Co. Rescue RCLAFA, INC. Rutherford Co. Rescue Application You are only allowed to check one that you are applying for: Reserve Status Specialty Rescue Team Part-Time Paid Employee This application must be completely

More information

(e) Revocation is the invalidation of any certificate held by the educator.

(e) Revocation is the invalidation of any certificate held by the educator. Effective October 15, 2009 505-6-.01 THE CODE OF ETHICS FOR EDUCATORS (1) Introduction. The Code of Ethics for Educators defines the professional behavior of educators in Georgia and serves as a guide

More information

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training State of Florida Department of Health Board of Osteopathic Medicine Application for Registration as an Osteopathic Physician in Training Board of Osteopathic Medicine 4052 Bald Cypress Way, #C-06 Tallahassee,

More information

APPLICATION FOR EMPLOYMENT/VOLUNTEERING

APPLICATION FOR EMPLOYMENT/VOLUNTEERING Medical Rescue Team South 315 Cypress Way Pittsburgh, PA 15228-2218 412-343-5111 APPLICATION FOR EMPLOYMENT/VOLUNTEERING REV: 01/2014 Medical Rescue Team South Authority is an equal opportunity employer

More information

This is a Legal Document. By completing and signing this, you certify under

This is a Legal Document. By completing and signing this, you certify under APPLICATION FOR WYOMING REGISTERED NURSE LICENSURE with ADVANCE PRACTICE RECOGNITION (APRN) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this,

More information

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement)

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement) To: Employees with Conditional Offers of Employment Re: Background Checks All offers of employment or participation in any activity involving minors in a University sponsored program with The University

More information

CRIMINAL AND PERSONAL BACKGROUND CHECK POLICY

CRIMINAL AND PERSONAL BACKGROUND CHECK POLICY CRIMINAL AND PERSONAL BACKGROUND CHECK POLICY PURPOSE The purpose of this policy is to: Promote a safe environment for patients, employees, Trainees, Students, and other members of The University of Texas

More information

CRIMINAL BACKGROUND CHECK by Division of Criminal Investigation (DCI)

CRIMINAL BACKGROUND CHECK by Division of Criminal Investigation (DCI) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify, under penalty of perjury and subject to the provisions of Wyo. Stat.

More information

Wallace State Community College Health Science Division Background Check Policy. Guidelines for Background Check On Health Profession Students

Wallace State Community College Health Science Division Background Check Policy. Guidelines for Background Check On Health Profession Students Wallace State Community College Health Science Division Background Check Policy 1 Education of Health Science Division students at Wallace State Community College requires collaboration between the college

More information

Internship Application Student Teacher Acceptance

Internship Application  Student Teacher Acceptance Orange County Public Schools agrees to accept the following intern for : Internship Application Student Teacher Acceptance Internship Type: Junior Senior Field Experience: ( Field Experience hours for

More information

VOLUNTEER POLICY & PROCEDURES

VOLUNTEER POLICY & PROCEDURES 3-9 VOLUNTEER POLICY & PROCEDURES MISSION OF SPECIAL OLYMPICS COLORADO The Mission of Special Olympics Colorado (SOCO) is to provide year-round sports training and athletic competition in a variety of

More information

USABLE CORPORATION TRUE BLUE PPO NETWORK PRACTITIONER CREDENTIALING STANDARDS

USABLE CORPORATION TRUE BLUE PPO NETWORK PRACTITIONER CREDENTIALING STANDARDS USABLE CORPORATION TRUE BLUE PPO NETWORK PRACTITIONER CREDENTIALING STANDARDS ELIGIBLE DISCIPLINES: Chiropractors Optometrists Podiatrists Advance Nurse Practitioners Certified Nurse-Midwives Clinical

More information

Be it enacted by the General Assembly of the Commonwealth of Kentucky: Section 1. KRS is amended to read as follows:

Be it enacted by the General Assembly of the Commonwealth of Kentucky: Section 1. KRS is amended to read as follows: AN ACT relating to the prescriptive authority of advanced practice registered nurses. Be it enacted by the General Assembly of the Commonwealth of Kentucky: Section. KRS.0 is amended to read as follows:

More information

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this, you certify under penalty of

More information

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify under

More information

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify, under

More information

LIVING WORD CHRISTIAN SCHOOL CODE OF ETHICS

LIVING WORD CHRISTIAN SCHOOL CODE OF ETHICS Living Word Christian School accepts this code of ethics put forth by the Department of Education with the exception that nothing in these paragraphs shall be construed as limiting our freedom to teach

More information

Section (1), Stats. Statutory authority: Sections (5) (b), (2) (a), and (1), Stats. Explanation of agency authority:

Section (1), Stats. Statutory authority: Sections (5) (b), (2) (a), and (1), Stats. Explanation of agency authority: STATE OF WISCONSIN MEDICAL EXAMINING BOARD IN THE MATTER OF RULE-MAKING : PROPOSED ORDER OF THE PROCEEDINGS BEFORE THE : MEDICAL EXAMINING MEDICAL EXAMINING BOARD : BOARD : ADOPTING RULES : (CLEARINGHOUSE

More information

APPLICATION FOR CERTIFICATION

APPLICATION FOR CERTIFICATION APPLICATION FOR CERTIFICATION SEX OFFENDER TREATMENT PROVIDER ASSOCIATE PROVIDER LEVEL California 1608 T Street, Sacramento, CA 95811 Website: www.casomb.org Contact Information for Inquiries Regarding

More information

APPLICATION FOR CERTIFICATION

APPLICATION FOR CERTIFICATION APPLICATION FOR CERTIFICATION SEX OFFENDER TREATMENT PROVIDER ASSOCIATE PROVIDER LEVEL California 1515 S Street, 212- North, Sacramento, CA 95811 Website: www.casomb.org Contact Information for Inquiries

More information

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE with ADVANCE PRACTICE RECOGNITION *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE with ADVANCE PRACTICE RECOGNITION *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING LICENSED REGISTERED NURSE with ADVANCE PRACTICE RECOGNITION *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document,

More information

JOHNSTON COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING. READMISSION to JCC NURSING

JOHNSTON COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING. READMISSION to JCC NURSING JOHNSTON COMMUNITY COLLEGE ASSOCIATE DEGREE NURSING READMISSION to JCC NURSING A student who is academically ineligible to continue in the Nursing Program or who has exited the program for personal reasons

More information

enlc Licensing Tier Matrix Approved 5/11/17 Revised 8/7/17 Revised 1/10/18

enlc Licensing Tier Matrix Approved 5/11/17 Revised 8/7/17 Revised 1/10/18 enlc Licensing Tier Matrix Approved 5/11/17 Revised 8/7/17 Revised 1/10/18 Violations not listed below will be discussed initially with the Executive Director. If there is a question, the application will

More information

NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD

NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD Mailing Address: Post Office Box 5549, Cary, NC 27512 Phone: (919) 469-8081 Fax: (919) 336-5156 Email: ncmftlb@nc.rr.com Web: www.nclmft.org APPLICATION

More information

Text Facsimile of Online Medical Radiologic Technologist Application

Text Facsimile of Online Medical Radiologic Technologist Application Applicant First Name: ID: License Type: Amount Paid: Applicant Last Name: Transaction Date: Trace Number: Text Facsimile of Online Medical Radiologic Technologist Application Login Medical Radiologic Technologist

More information

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING NURSING ASSISTANT CERTIFICATION (CNA) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify, under

More information

PERSONNEL SERVICES Form 4120 APPLICATION FOR A CERTIFICATED POSITION

PERSONNEL SERVICES Form 4120 APPLICATION FOR A CERTIFICATED POSITION PERSONNEL SERVICES Form 4120 Employment Employment Application - Certificated Staff APPLICATION FOR A CERTIFICATED POSITION The School District considers applicants for all positions without regard to

More information

POLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8

POLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8 POLICY TITLE: Code of Ethics for Certificated Employees POLICY NO: 442 PAGE 1 of 8 It is the policy of this district that all certificated employees shall adhere to the Code of Ethics for Idaho Professional

More information

BOC Standards of Professional Practice. Version Published October 2017 Implemented January 2018

BOC Standards of Professional Practice. Version Published October 2017 Implemented January 2018 BOC s of Professional Practice Implemented January 2018 Introduction The BOC s of Professional Practice is reviewed by the Board of Certification, Inc. (BOC) s Committee and recommendations are provided

More information

Football & Cheerleading. Youth Sports Coaches Volunteer Application

Football & Cheerleading. Youth Sports Coaches Volunteer Application Football & Cheerleading Youth Sports Coaches Volunteer Application YOUTH SPORTS VOLUNTEER JOB DESCRIPTION TITLE: DESCRIPTION: Volunteer Coach for Gainesville Parks and Recreation Agency. *Coach of male

More information

Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A REGISTERED NURSE

Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A REGISTERED NURSE Vermont Secretary of State 89 Main St., 3 rd Floor Montpelier VT 05620-3402 Nursing (802) 828-2396 www.vtprofessionals.org INSTRUCTION TO APPLICANTS FOR LICENSURE AS A REGISTERED NURSE NCLEX RETAKE (Domestic)

More information

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING ADVANCE PRACTICE REGISTERED NURSE LICENSE *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify under

More information

City of Pigeon Forge Police Department. Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer.

City of Pigeon Forge Police Department. Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer. City of Pigeon Forge Police Department Position: The City of Pigeon Forge Police Department is accepting applications for Communications Officer. Qualifications: Must be at least eighteen years of age

More information

Waccamaw Economic Opportunity Council, Inc Highway 501 East, Suite B, Conway, SC 29526

Waccamaw Economic Opportunity Council, Inc Highway 501 East, Suite B, Conway, SC 29526 Waccamaw Economic Opportunity Council, Inc. 1261 Highway 501 East, Suite B, Conway, SC 29526 The Community Action Agency serving Horry, Georgetown and Williamsburg Counties EMPLOYMENT APPLICATION (WE ARE

More information

POLICY NO Volunteer Policy (Replaces Policy Adopted 1/26/1998)

POLICY NO Volunteer Policy (Replaces Policy Adopted 1/26/1998) POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 1/26/1998) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of

More information

YALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST

YALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST YALE-NEW HAVEN HOSPITAL MEDICAL STAFF POLICY & PROCEDURE CONFLICT OF INTEREST Definitions External financial interests can create conflicts when they provide an incentive to a Medical Staff member to affect

More information

ENROLLMENT APPLICATION

ENROLLMENT APPLICATION Alabama Medicaid ENROLLMENT APPLICATION LIMITED ENROLLMENT AS A NON-MEDICAID PROVIDER FOR ORDERING, PRESCRIBING OR REFERRING (OPR) PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS In accordance with the implementation

More information

Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A LICENSED NURSING ASSISTANT

Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE AS A LICENSED NURSING ASSISTANT Vermont Secretary of State Office of Professional Regulation 89 Main St., 3 rd Floor Montpelier VT 05620-3402 Nursing (802) 828-3089 www.vtprofessionals.org Vermont Board of Nursing INSTRUCTION TO APPLICANTS

More information

Vermont Board of Nursing INSTRUCTION TO APPLICANTS

Vermont Board of Nursing INSTRUCTION TO APPLICANTS Vermont Secretary of State 89 Main St., 3 rd Floor Montpelier VT 05620-3402 Nursing Foreign_nurse@sec.state.vt.us www.vtprofessionals.org INSTRUCTION TO APPLICANTS NCLEX RETAKE (International) Applicant

More information

SCHOOL BUS DRIVER APPLICATION

SCHOOL BUS DRIVER APPLICATION SCHOOL BUS DRIVER APPLICATION SCHOOL CITY OF HOBART SERVICE CENTER 200 SOUTH HOBART ROAD HOBART, INDIANA 46342 Social Security # Contact Phone # Name (Last) (First) (Middle) Permanent Address (Street)

More information

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE (RN) *All licenses expire December 31 of every EVEN year*

APPLICATION FOR WYOMING LICENSED REGISTERED NURSE (RN) *All licenses expire December 31 of every EVEN year* APPLICATION FOR WYOMING LICENSED REGISTERED NURSE (RN) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this document, you certify under penalty

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT Human Resources Use Only Email/postcard sent: Meets Requirements: Yes No Interview Date: Interview Time: Offer: Date: 6133 The Plaza, Charlotte, NC 28215 Phone: (704) 887-3840 Fax: (704) 887-3844 APPLICATION

More information

Information in State statutes and regulations relevant to the National Background Check Program: Washington

Information in State statutes and regulations relevant to the National Background Check Program: Washington Information in State statutes and regulations relevant to the National Background Check Program: Washington This document describes what was included as of February 2011 in Washington statutes and regulations

More information

KANSAS STATE BOARD OF NURSING Landon State Office Building 900 SW Jackson, Ste 1051 Topeka, KS (785)

KANSAS STATE BOARD OF NURSING Landon State Office Building 900 SW Jackson, Ste 1051 Topeka, KS (785) KANSAS STATE BOARD OF NURSING Landon State Office Building 900 SW Jackson, Ste 1051 Topeka, KS 66612-1230 (785) 296-4929 INSTRUCTIONS FOR COMPLETION OF RENEWAL APPLICATION Online Renewal is available!!!

More information

DURANGO SCHOOL DISTRICT 9-R Application for AUTHORIZED VOLUNTEER status

DURANGO SCHOOL DISTRICT 9-R Application for AUTHORIZED VOLUNTEER status DURANGO SCHOOL DISTRICT 9-R Application for AUTHORIZED VOLUNTEER status Volunteers shall be required to make written application for specified voluntary services and the appropriate school principal or

More information

COMPLAINT FORM CONSENT AND RELEASE

COMPLAINT FORM CONSENT AND RELEASE COMPLAINT FORM CONSENT AND RELEASE This form must be completed whenever the BACB investigates a complaint that involves the provision of services to an adult, legal minor and/or incapacitated individual

More information

Text Facsimile of Online Physician Licensure Application

Text Facsimile of Online Physician Licensure Application Text Facsimile of Online Physician Licensure Application Login Physician Licensure Application Information you enter will automatically saved at the end of every page. You must complete the application

More information

Felony Mental Health Court Success Through Addiction Recovery Drug Court Program Veterans Court

Felony Mental Health Court Success Through Addiction Recovery Drug Court Program Veterans Court CAUSE NO. The State of Texas In the District Court v. of Harris County, Texas Defendant Judicial District HARRIS COUNTY SPECIALTY COURT PROGRAM PARTICIPANT CONTRACT Name: DOB: _ Address: Cell No: _ Email:

More information

Pennsylvania State Board of Barber Examiners

Pennsylvania State Board of Barber Examiners This application is for Applicants that have an existing license that has been expired for five (5) years or more. Pennsylvania State Board of Barber Examiners REINSTATEMENT APPLICATION FOR PROFESSIONAL

More information

Basis for Disciplinary Action Definitions and Descriptions

Basis for Disciplinary Action Definitions and Descriptions The Federation of State Boards of Physical Therapy Basis for Disciplinary Action Definitions and Descriptions A tool to assist physical therapy regulatory bodies categorize the basis for disciplinary action

More information

NORTH DAKOTA BOARD OF NURSING INSTRUCTIONS FOR ADVANCED PRACTICE with or without PRESCRIPTIVE AUTHORITY LATE LICENSE RENEWAL (SFN 50924)

NORTH DAKOTA BOARD OF NURSING INSTRUCTIONS FOR ADVANCED PRACTICE with or without PRESCRIPTIVE AUTHORITY LATE LICENSE RENEWAL (SFN 50924) NORTH DAKOTA BOARD OF NURSING INSTRUCTIONS FOR ADVANCED PRACTICE with or without PRESCRIPTIVE AUTHORITY LATE LICENSE RENEWAL (SFN 50924) INSTRUCTIONS/REQUIREMENTS - Please renew online at www.ndbon.org

More information

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER

GLYNN COUNTY SHERIFF S OFFICE IS AN EQUAL OPPORTUNITY EMPLOYER 100 Sulphur Springs Road Brunswick, GA 31520 Telephone: (912) 554-7600 Web Page Address: www.glynncountysheriff.org INSTRUCTIONS AND INFORMATION PLEASE READ CAREFULLY BEFORE BEGINNING 1. Please complete

More information

Application for Admission

Application for Admission Application for Admission Three Neshaminy Interplex Trevose, PA 19053 Phone (215) 710-3531 Fax (215) 710-3511 http://www.ariahealth.org/nursing Instructions Please read all instructions and information

More information

Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE

Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE Vermont Secretary of State Office of Professional Regulation 89 Main St., 3 rd Floor Montpelier VT 05620-3402 Nursing Foreign_nurse@sec.state.vt.us www.vtprofessionals.org Vermont Board of Nursing INSTRUCTION

More information

922 Ky. Admin. Regs. 2: KAR 2:020. Child Care Assistance Program (CCAP) improper payments, claims, and penalties

922 Ky. Admin. Regs. 2: KAR 2:020. Child Care Assistance Program (CCAP) improper payments, claims, and penalties 922 Ky. Admin. Regs. 2:020 922 KAR 2:020. Child Care Assistance Program (CCAP) improper payments, claims, and penalties Section 1. Definitions. (1) Agency error means an error on the part of the cabinet

More information

Employment Application

Employment Application SOURCE (Fields marked with an * are required) Advertisements please list: Employment Agency Name: College/University Recruiting please list: Internal Applicant: Current Employee Volunteer Corporate Website

More information

Provider Credentialing

Provider Credentialing I. Purpose The purpose of this Policy and Procedure is to establish the process including written guidelines and standards for the credentialing and re-credentialing of all clinicians defined in this policy.

More information

POLICY NO Volunteer Policy (Replaces Policy Adopted 12/13/2011)

POLICY NO Volunteer Policy (Replaces Policy Adopted 12/13/2011) POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 12/13/2011) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of

More information

MEDICAID ENROLLMENT PACKET

MEDICAID ENROLLMENT PACKET MEDICAID ENROLLMENT PACKET Follow the steps below. This will prevent errors which will delay enrollment. Physicians Only: 1. Answer the one page questionnaire 2. SIGN EACH FORM where it indicates Signature

More information

HEALTH GENERAL PROVISIONS CAREGIVERS CRIMINAL HISTORY SCREENING REQUIREMENTS

HEALTH GENERAL PROVISIONS CAREGIVERS CRIMINAL HISTORY SCREENING REQUIREMENTS TITLE 7 CHAPTER 1 PART 9 HEALTH HEALTH GENERAL PROVISIONS CAREGIVERS CRIMINAL HISTORY SCREENING REQUIREMENTS 7.1.9.1 ISSUING AGENCY: New Mexico Department of Health. [7.1.9 1 NMAC - Rp, 7.1.9.1 NMAC, 01/01/06]

More information

SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET

SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET SUMMER INTENSIVE RESIDENT ASSISTANT APPLICATION PACKET Dear Applicant, Thank you for your interest in the Milwaukee Ballet Summer Intensive Resident Assistant Position. Resumes will be collected until

More information

MULTISTATE LICENSE APPLICATION

MULTISTATE LICENSE APPLICATION MULTISTATE LICENSE APPLICATION for LICENSED REGISTERED NURSE or LICENSED PRACTICAL/VOCATIONAL NURSE with an active Wyoming license This is a Legal Document. By completing and signing this document, you

More information

Filer Police Department 300 Main Street Office: P.O. Box 140 Dispatch: Filer, Idaho Fax:

Filer Police Department 300 Main Street Office: P.O. Box 140 Dispatch: Filer, Idaho Fax: Filer Police Department 300 Main Street Office: 208 326-4123 P.O. Box 140 Dispatch: 208 735-1911 Filer, Idaho 83328 Fax: 208 326-5004 www.cityoffiler.com 911 Emergency EQUAL OPPORTUNITY EMPLOYER Prospective

More information

Please accurately complete the entire application. No action will be taken on applications with missing information.

Please accurately complete the entire application. No action will be taken on applications with missing information. 2508 E. Fox Farm Road, 1-1A Cheyenne, WY 82007 (307) 635-3618 Fax: (307) 635-1442 www.wyhealthworks.org Application for Employment (HealthWorks does not discriminate based on color, creed, religion, national

More information

Frequently Asked Questions

Frequently Asked Questions 450 Simmons Way #700, Kaysville, UT 84037 (801) 547-9947 unar@davistech.edu www.utahcna.com Frequently Asked Questions UNAR stands for the Utah Nursing Assistant Registry, the agency in charge of the registry

More information

APPLICATION CHECKLIST IMPORTANT

APPLICATION CHECKLIST IMPORTANT State of Florida Department of Business and Professional Regulation Division of Professions: Talent Agencies Application for Change of Owner or Operator Form # DBPR TA-2 APPLICATION CHECKLIST IMPORTANT

More information

Registered Nurse Renewal Application

Registered Nurse Renewal Application Vermont Secretary of State Attn: Renewal Clerk Office of Professional Regulation 89 Main St. 3 rd Floor Montpelier, VT 05620-3402 Current Expiration 03/31/2013 You Must Complete The Information Below:

More information

RULES OF PROFESSIONAL CONDUCT FOR LAW STUDENTS CERTIFICATION FORM

RULES OF PROFESSIONAL CONDUCT FOR LAW STUDENTS CERTIFICATION FORM RULES OF PROFESSIONAL CONDUCT FOR LAW STUDENTS I, (Print Name), certify that I have read the Rules of Professional Conduct for Law Students (the Honor Code). I understand that the Rules apply to conduct

More information

South Carolina Radiation Quality Standards Association Code of Ethics

South Carolina Radiation Quality Standards Association Code of Ethics South Carolina Radiation Quality Standards Association Code of Ethics 1. Introduction a. Code of ethics. These rules of conduct constitute the code of ethics as required by the Code of Laws of South Carolina.

More information

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing. 1 of 11 State of Florida Department of Business and Professional Regulation Building Code Administrators and Inspectors Board Application for Authorization to Take the Principles and Practice Examination

More information

A $ application fee in the form of a money order made payable to LSBN must accompany this form.

A $ application fee in the form of a money order made payable to LSBN must accompany this form. OFFICE USE ONLY: APPROVED BY (initial) DATE PERMIT ISSUED RN LICENSE NUMBER DATE RN LICENSE ISSUED ATTACH 2 X 2 PHOTO With tape only - Attach a 2 x 2 inch passport type, fade-proof photo taken in the last

More information

Once accepted into the Program applicant will be required to pass a physical exam.

Once accepted into the Program applicant will be required to pass a physical exam. 5800 Uvalde Road Bldg. 17, Office 2114 Houston, Texas 77049 281-998-6150 Ext: 7132 vnnursingnorth@sjcd.edu Name: G00 Application for Vocational Nursing Program-North Campus: This application and this checklist

More information

Admission Requirements

Admission Requirements Admission Requirements All Applicants: ATI TEAS V entrance exam is required for ALL applicants in addition the requirements listed below. Applicants must have at least a 60% Adjusted Individual Total Score

More information

IN THE SUPERIOR COURT OF CHATHAM COUNTY STATE OF GEORGIA SAVANNAH-CHATHAM COUNTY DRUG COURT CONTRACT

IN THE SUPERIOR COURT OF CHATHAM COUNTY STATE OF GEORGIA SAVANNAH-CHATHAM COUNTY DRUG COURT CONTRACT IN THE SUPERIOR COURT OF CHATHAM COUNTY STATE OF GEORGIA STATE OF GEORGIA vs. Case No., Defendant SAVANNAH-CHATHAM COUNTY DRUG COURT CONTRACT You are voluntarily entering the Savannah-Chatham County Drug

More information

Guidelines for Professionalism, Licensure, and Personal Conduct The American Board of Family Medicine (ABFM) Version

Guidelines for Professionalism, Licensure, and Personal Conduct The American Board of Family Medicine (ABFM) Version I. Professionalism Guidelines for Professionalism, Licensure, and Personal Conduct The American Board of Family Medicine (ABFM) Version 2017-5 Adopted Effective 1/29/2017 Professionalism is the basis of

More information

BACKGROUND CHECK PROGRAM

BACKGROUND CHECK PROGRAM BACKGROUND CHECK PROGRAM Effective July 1, 2018 I. PURPOSE OF BACKGROUND CHECK The purpose of the Department of Recreation and Parks Background Check Program is to ensure that every individual who interacts

More information

CHAPTER MEDICAL IMAGING AND RADIATION THERAPY

CHAPTER MEDICAL IMAGING AND RADIATION THERAPY CHAPTER 43-62 MEDICAL IMAGING AND RADIATION THERAPY 43-62-01. Definitions. 1. "Board" means the North Dakota medical imaging and radiation therapy board of examiners. 2. "Certification organization" means

More information

1. NAME: 2. SOCIAL SECURITY NO.: Last First Middle (As it appears on your Social Security Card)

1. NAME: 2. SOCIAL SECURITY NO.: Last First Middle (As it appears on your Social Security Card) U 2BTEXAS DEPARTMENT OF CRIMINAL JUSTICE 0BUEMPLOYMENT APPLICATION SUPPLEMENT U UPlease check those that apply U New Applicant Former Employee Veteran s Reinstatement ERS Retiree INSTRUCTIONS: All questions

More information

Registered Nurse Renewal/Reinstatement Application

Registered Nurse Renewal/Reinstatement Application Vermont Secretary of State Attn: Renewal Clerk Office of Professional Regulation 89 Main St. 3 rd Floor Montpelier, VT 05620-3402 Board of Nursing (802) 828-2396 www.vtprofessionals.org Current Expiration

More information

PATIENT NOTICE OF PRIVACY PRACTICES Effective Date: June 1, 2012 Updated: May 9, 2017

PATIENT NOTICE OF PRIVACY PRACTICES Effective Date: June 1, 2012 Updated: May 9, 2017 PREMIER PSYCHIATRY Psychiatric and Behavioral Health Services PATIENT NOTICE OF PRIVACY PRACTICES Effective Date: June 1, 2012 Updated: May 9, 2017 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES NOTICE OF PRIVACY PRACTICES Effective Date: May 31, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW

More information

Practitioner Credentialing Criteria for Participation and Termination

Practitioner Credentialing Criteria for Participation and Termination Practitioner Credentialing Criteria for Participation and Termination I. Statement of Purpose Regence (referred to hereinafter as the Company ) is firmly committed to the development of networks with practitioners

More information

License Requirements in addition to requirements outlined below (Documentation must be provided):

License Requirements in addition to requirements outlined below (Documentation must be provided): APPLICATION FOR WYOMING FOREIGN EDUCATED LICENSED PRACTICAL NURSE/REGISTERED NURSE (LPN/RN) *All licenses expire December 31 of every EVEN year* This is a Legal Document. By completing and signing this

More information

Volusia County Schools. Office Of Professional Standards. General Information Manual

Volusia County Schools. Office Of Professional Standards. General Information Manual Volusia County Schools Office Of Professional Standards General Information Manual Updated April 7, 2016 INTEROFFICE MEMORANDUM TO: FROM: SUBJECT: ALL EMPLOYEES Mr. James T. Russell Superintendent of Schools

More information

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply.

AMHERST COUNTY SHERIFF'S OFFICE An equal opportunity employer Women and Minorities are encouraged to apply. An equal opportunity employer Women and Minorities are encouraged to apply. Sheriff E.W. Viar Jr. P.O. BOX 410, 115 TAYLOR STREET, AMHERST, VIRGINIA 24521 BUSINESS 434.946.9381 ~ ADMINISTRATION 434.946.9301

More information