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WORKFORCE BACKGROUND CHECK CONSENT AND …

STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS DEPARTMENT OF HUMAN SERVICES LANSING WORKFORCE BACKGROUND CHECK CONSENT AND DISCLOSURE Part 1 CONSENT Part 2 Applicant Information Part 3 Disclosure Part 4 Conditional employment Part 5 Applicant Rights Part 6 Disclaimer MCL , MCL , and MCL require that a health facility/agency that is a: psychiatric facility hospital that provides swing bed services ICF/MR home for the aged nursing home home health agency county medical care facility adult foster care facility (AFC) hospice Shall not employ, independently contract with, or grant clinical privileges to an individual who regularly has direct access to or provides direct services to patients or residents in the health facility/agency or AFC until the health facility/agency or AFC conducts a fingerprint-based criminal history CHECK .

Part 1 – Consent to Conduct Background and Criminal Record Checks As a condition of being considered for employment: a. I hereby consent to and authorize the health facility/agency or AFC to conduct a background check that

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