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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 pati

WORKFORCE BACKGROUND CHECK CONSENT AND DISCLOSURE Part 1 – Consent Part 2 – Applicant Information Part 3 – Disclosure Part 4 – Conditional Employment ... DCH-1360 (04/11) Page 1 of 5 . Part 1 – Consent to Conduct Background and Criminal Record Checks

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