APPLICATION
GUIDELINES
FOR
ILLINOIS
NURSE ASSISTANT/AIDE PROGRAM
COORDINATORS/INSTRUCTORS
SIUC
Nurse Aide Testing Program
and
Illinois
Department of Public Health
2007
TABLE OF CONTENTS
Page
COMPLYING WITH BACKGROUND CHECK
REQUIREMENTS
Community College and Facility Based
Nurse
Aide
Training Programs Requirements 3
High School Based Nurse Aide
Training Programs
and IDPH Assigned Codes Requirements 3
Initiated
through SIUC Nurse Aide Testing 4
Initiated through someone other than SIUC Nurse Aide Testing 6
CRIMINAL BACKGROUND CHECK APPLICATION GUIDELINES
Criminal Background Check
Application Information 7
Important reminders 7
Submitting the applications 8
Non-fingerprint background
check fee 8
Nurse
Aide Training Program Responsibilities 8
Maintain adequate supply of materials 8
Criminal background check verification 9
Assist students in completing application forms 9
Collect appropriate fees 9
Assemble application forms for mailing 10
Criminal
Background Check Application Procedures 11
Verbal application
completion instructions to students 11
Verbal fee information to students 13
Criminal
Background Check Results 14
Distribution of results 14
APPENDICES
Appendix
A - Criminal background check material request form 16
Appendix B - Sample background check
submission cover letter
and nurse aide training program class roster 17-18
COMPLYING WITH
CRIMINAL BACKGROUND CHECK REQUIREMENTS
Community College and Facility
Based Nurse Aide Training Programs:
The Health Care
Worker Background Check Act was amended in February 1998 and stipulated that:
a) An educational entity, other than a secondary school, conducting a nurse aide training program shall initiate a UCIA criminal history records check in accordance with the requirements of the Health Care Worker Background Check Act prior to entry of an individual into the training program.
b) For the purpose of this section,
"INITIATE" means the obtaining of the authorization for a record
check from a student. The educational
entity shall transmit all necessary information and fees to the
Background check
results that have been initiated through SIUC Nurse Aide Testing will be
reported to IDPH with the individual’s test results by SIUC Nurse Aide
Testing. Result data for background
checks that have been initiated by any persons or facilities other than SIUC
Nurse Aide Testing must be reported directly to IDPH by the person or agency
who initiated the background check. The
background check report must be from the Illinois State Police and have the
individual's social security number written on the background report next to
the individual's name.
High School Based Nurse Aide
Training Programs
Illinois Department of Public Health
Guidelines regarding criminal background checks for high school based programs
states that secondary students are not required to have a criminal background
check conducted at the time of testing.
However, when an applicant applies to work in a long term care facility
in
IDPH Assigned Codes:
The Health Care Worker Background Check Act requires that persons with IDPH assigned special training codes have a criminal background check conducted at the time they apply to take the Illinois Nurse Aide Competency Exam, unless they have attached an Illinois State Police Criminal Background check that is LESS than one year old. Applicants must submit a red Illinois Criminal Background Check application form and $15.00 background check fee at the same time as they submit the lavender Illinois Nurse Assistant Competency Exam application form and $50.00 exam fee.
Nurse Aide Testing will provide the service of requesting
the background check required of nurse aides.
We will manage requesting and reporting for the same price that
individuals pay for individual paper-processed non-fingerprint background checks.
THIS SERVICE IS AVAILABLE ONLY TO APPROVED
Criminal Background Check Initiated Through SIUC Nurse Aide
Testing
Community College and
Facility Based Nurse Aide Training Program responsibilities:
·
On the first
day of class, have the student complete the red Illinois Criminal Background Check Application Form For
Nurse Assistants/ Home Health Aides using a No. 2 pencil and instruct them to
bring a money order to cover the processing fee of $15.00 to the next class.
·
Attach money
orders or a facility check to the corresponding CBC applications.
·
Attach a typed
cover letter and typed roster of name of the students applying for a criminal
background check (as shown in Appendix B) to the application materials.
·
Send the
completed CBC application materials packet to Nurse Aide Testing within the
first ten days of the class beginning date.
Fees are payable only by institutional checks or money orders made out to
SIUC. (All Forms Of Payment Must Be
Original Documents - No Copies Will Be Accepted!)
High School Based
Nurse Aide Training Programs and IDPH Assigned Codes Responsibilities:
·
It is
suggested that on the same day that the student completes the lavender Application Form For
Illinois Nurse Assistant/Home Health Aide Competency Exam, also have the
student complete the red
Illinois Criminal Background Check Application Form For Nurse Assistants/Home
Health Aides using a No. 2 pencil and collect the $15 processing fee. (see page 3 for guidelines regarding high
school based programs)
·
Send both
completed forms (LAVENDER & RED) and both fees ($50.00 and $15.00 to Nurse
Aide Testing at the address shown on page 9 of this guide. Fees are payable only by institutional
checks, certified checks or money orders made out to SIUC. (All Forms Of Payment Must Be Original Documents - No Copies Will Be
Accepted!) One money order for $65
is acceptable.
Nurse Aide Testing
responsibilities:
·
Nurse Aide
Testing will process the requests to the State Police twice per month.
·
Background
check results will be mailed to each applicant within approximately 10 working
days of the processing date.
·
Program
reports will be mailed to the designated program official.
·
A second
report after an initial pending result will be mailed to the individual when
received. NOTE: There is no time
guarantee from the Illinois State Police (ISP) when pending result updates will
be received.
·
Background
check results will be sent to the nurse aide registry with the nurse aide
competency test results.
Program
responsibilities:
·
Meet with
students to verify receipt of background check results.
·
Persons with
multiple records, pending results and those with criminal background history
will be contacted by the Illinois Department of Public Health with information
about the next procedure to follow.
·
Submit a copy
of the criminal background report for your program as received from SIU Nurse
Aide Testing to IDPH along with the official class roster. (NOTE: If the criminal background check is initiated
by anyone other than SIU Nurse Aide Testing a copy of the official results as
received from the Illinois State Police must be sent to the Illinois
Department of Public Health by the person or agency who initiated the
background check if the individual is working in a direct care
environment. Also, a copy of the
Summary of
procedures:
·
SIUC Nurse
Aide Testing will provide the approved programs with “background check” forms.
·
The completed
background check form and $15.00 will be collected from each student. (Applies
only to those students who have not
previously completed a non-fingerprint Illinois State Police background
check.) If a student has a current
Illinois State Police background check report they do not need to initiate a
new background check, but must attach a copy of the result report to the test
application when applying for the Nurse Aide Competency Exam.
·
Completed
forms and checks sent to SIUC Nurse Aide Testing.
·
Background
check forms will be processed to Illinois State Police.
·
Background
check results will be forwarded by letter to the individual and to the approved
program that generated the request.
·
Background
check results will be sent to the nurse aide registry with the nurse aide
competency exam results.
Criminal Background Checks Not Initiated by SIU Nurse Aide
Testing
If someone other than
Nurse Aide Testing at SIUC initiates the background check for your students,
the person or agency who initiated the check must send the results of the
background check directly to the Nurse Aide Registry.
Second reports from a
pending status are mailed to the original requester and therefore, must be
reported directly to IDPH. When submitting applications for the Illinois
Nurse Assistant/Home Health Aide Competency Exam to SIU Nurse Aide Testing for
individual’s who’s background check was initiated by someone other than SIUC, a
copy of the applicant's criminal background check report must be paper clipped
to the individual’s exam application form.
Copies of the reports must have the individual’s social security number
written on the report next to the individual’s name.
CRIMINAL BACKGROUND CHECK
APPLICATION GUIDELINES
CRIMINAL BACKGROUND CHECK APPLICATION INFORMATION
The purpose of this
section is to assist the instructor/coordinator in helping students properly
fill out the criminal background check application form for the non-fingerprint
criminal background check. This section:
a. outlines responsibilities for program
coordinators/instructors.
b. explains the steps for completing the
application form.
c. provides information on fees and background
check results.
IMPORTANT REMINDERS:
Training programs must:
1. submit Illinois State Police Criminal
Background Check applications for all students who are enrolled in their
training program who wish to initiate a background check through SIUC Nurse
Aide Testing using a red Illinois Criminal Background Check Application Form
and a $15.00 fee within ten days of the training program starting date. This service is available ONLY to approved
Illinois Nurse Aide Training programs and MUST be accompanied by a typed cover
letter and a typed student roster (Appendix B).
CBC report applications may be submitted only by approved Illinois Nurse
Aide Training Programs, individual’s who previously sat for the Illinois Nurse
Aide Exam (Failed or No Showed) or that have been submitted through and
approved by the Illinois Department of Public Health will be processed by SIUC
Nurse Aide Testing.
2. insure that all CBC applications are
completed using a No. 2 (Soft lead) pencil to fill out the application form.
3. verify that all ovals have been filled
in below the written information accurately and completely.
4. verify that all required application
information has been coded and the individual has signed the application form.
5. check the application forms for
accuracy before mailing.
6. verify that all payments are in the
form of a money order or a facility check made out to SIUC.
7. not staple, glue, tape payment to the
application forms; paper clip only. DO NOT FOLD APPLICATIONS.
8. submit application forms for students
that have completed their training program only and who have completed training
LESS than 24 months ago.
DO
NOT STAPLE OR USE ANY FORM OF GLUE OR TAPE
TO ATTACH THE MONEY ORDERS TO THE
APPLICATIONS. THIS WILL RESULT IN THE
APPLICATION’S BEING RETURNED.
INCORRECTLY COMPLETED APPLICATION FORM PACKETS WILL NOT BE
PROCESSED. ALL MATERIALS WILL BE
RETURNED TO THE TRAINING PROGRAM FOR CORRECTION.
Submitting the Applications
After the individual
has completed the Application Form, the program coordinator/instructor must
check to make sure that all information is provided, all information is
correctly coded, and that the application has been completed in pencil. Clip the money order made payable to SIU-C to
the application form using a paper clip.
Non-fingerprint Background Check Fee
The non-fingerprint background check fee is $15. All fees sent to the testing center must be
in the form of a Money Order payable to Southern Illinois University at
NURSE AIDE TRAINING PROGRAM
RESPONSIBILITIES
The
instructor/program coordinator is responsible for ensuring that the application
process is made as easy as possible for the student. If you need telephone assistance in filling
out the application, please call 618-453-4368.
Maintain Adequate Supply of
Application Materials
Each program sponsor
should maintain a supply of application materials which should include:
a. criminal
background check application forms (red).
b.
Instructor/coordinator’s
guidelines for completing the background check application (pink).
Additional material
may be obtained, on request, from the testing center. For
the quickest response please FAX your requests to the Nurse Aide Testing
office. The Fax Number is (618)
453-4300. Requests for additional
material should be made on the re-order forms provided (See Appendix A for
the re-order form).
Criminal Background Check
Verification
Students are not required
to have another background check if one has been completed in the last 12
months. Previously completed background
checks must be sent to the Illinois Department of Public Health when the
program submits the official class roster (list of students who successfully
complete the training program). Copies of background check results
initiated by agencies other than SIUC Nurse Aide Testing must be paper clipped
to the nurse aide competency exam application form. The applicant's social security number must
be written on each criminal background report next to the individual's name.
Assist Students in Completing
Application Forms
Instructors/program
coordinators should familiarize themselves with the background check
application material. Registration should
be done as a supervised group activity.
Within the first ten days of class, the instructor/program coordinator
should distribute the application to the students. The instructor/program coordinator should
read the application completion procedure to the students as outlined on pages
11-13 helping them to complete the process accurately. Any
errors in the completion of the application forms will result in delays in
processing the forms or postponement to the next
NOTE: The Healthcare worker Background Check Act
requires employers to verify a nurse aide’s standing on the Illinois Nurse Aide
Registry. If the Nurse Aide’s registry
record does not have a criminal record check that is LESS than one year old,
the employer is required to initiate the request for a new report.
Collect Appropriate Fees
The non-fingerprint
background check fee is $15.00.
Instructors/program coordinators should ensure that the correct fee is
collected from each student who
submits an application for a criminal background check. All
fees sent to the testing center must be in the form of a Money Order payable to
Southern
It is very important
that the instructor/program coordinator ensures that correct fees accompany
application forms. Forms that are accompanied by incorrect fees will be returned to the
program for correction and result in a delay in the processing.
Assemble Application Forms for
Mailing
It is the training
program’s responsibility to submit the background check application for
students enrolled in their program only.
Before mailing the application forms, the program should assemble all
criminal background check applications in the following manner:
a.
Clip the money
order for $15.00 made payable to SIU-C to the appropriate background check
application form using a paper clip. Or
clip the money order/check for a group of criminal background checks to the
group of applications.
b.
Place all
applications and money orders in a bundle with a cover letter and class roster
( See Appendix B ) indicating the total number of background check applications
being submitted and the total dollar amount enclosed. Place all materials in a large envelope (DO
NOT FOLD THE APPLICATIONS) and mail the package to:
NURSE AIDE TESTING
SOUTHERN
SIU MAILCODE
4340
NOTE: The
VERBAL INSTRUCTIONS FOR CRIMINAL BACKGROUND APPLICATION COMPLETION PROCEDURES
INSTRUCTORS, PLEASE READ THE
FOLLOWING INSTRUCTIONS TO YOUR STUDENTS AFTER HANDING OUT THE APPLICATION FORMS
AND NUMBER 2 LEAD PENCILS
Begin completing the Application Form on side one. Be sure to use a No. 2 pencil to complete the form. The
letters that follow correspond with the different parts on the Application
Form.
A.
Signature Line
Sign your
legal name. The student’s signature on
the application grants permission to the State of Illinois and any affiliate
acting on behalf of the State of Illinois to conduct a non-fingerprint criminal
history record check on the individual signing the application in accordance
with the Uniform Conviction Information Act and to provide said information to
the Illinois Department of Public Health in accordance with the Health Care
Worker Background Check Act. (See
Consent To Criminal Background Check box on the top center of side one above
the signature box on the application form).
Stay
within the designated areas for name and address. Print your complete name (Last name, First
name, Middle name).
B. Race
Darken
in the oval beside the race category your family most closely classifies
itself. Note: A race must be entered to complete an ISP background check. If
more than one race is identified, it will be transmitted to the
C. Name
In the first section, print your complete last name.
In the second section, print your
complete first name.
In the third section, print your
complete middle name.
Begin in the first space of each section!
Do not skip any spaces between letters; only leave a blank space if you have
more than one name, for example Mary Jo or Smith-Jones.
Now
code the information by filling in (darkening) the corresponding oval under
each letter, do not mark blank ovals.
D. Social Security Number
In the spaces provided, write your social security
number. Darken
the corresponding oval under each
digit.
E. Sex
Darken
in the oval beside your sex. Note: A sex
must be entered to complete an
ISP background check.
F. Eye Color
Darken in the oval beside your eye color.
Please turn to side 2 of the
application.
G. Mailing Address
Print
your complete street address and apartment number in the spaces provided. Darken the letter or number in the
corresponding ovals. Be sure to begin in the first space of each
section and leave a blank space after numbers or between words. Stay within the designated area.
H. City
In
the spaces provided, print the name of the city in which you receive your
mail. Begin in the first space and leave
a blank space between words. Darken the
corresponding ovals.
I. State
In the spaces provided, print the abbreviation of the state
in which you receive your mail. Darken the corresponding ovals.