Sample Application Verification Letter For Background Checks Not Initiated Through SIUC

(LETTERHEAD)

Current Date

Nurse Aide Testing
SIUC Mail Code 4340
Southern Illinois University
Carbondale, IL  62901-4340

Dear Test Coordinator,

Attached are typed alphabetized rosters of applicants who have completed the following approved Illinois Nurse Aide Training Program (name of training program), NA (training program number) on (program completion date) as indicated on the attached applicant rosters.  These applicants are eligible to take the Nurse Aide Competency Test on the date indicated on the applicant roster.

The results of the criminal history record check is attached to the student's competency test application and listed on the applicant roster along with the date the check was conducted.

The applications have been separated by test site location with a separate roster for the students applying to each test site or test date and sorted by type of application (1st time, retake, or reschedule) as indicated on page 9 of the application guidelines.  I have enclosed (total # of applications) application forms and fees in the amount of (total dollar amount ).  If you have questions, please contact me at (contact person’s phone number)

Sincerely,

(Signature of Instructor/Coordinator)

Instructor/Coordinator’s typed or printed name
Instructor/Coordinator’s official title

(SEE NEXT PAGE FOR ROSTER)

NOTE:  A separate cover letter must be done for each different program completion date.

 

Sample Nurse Aide Exam Applicant Rosters

NURSE AIDE EXAM APPLICANT ROSTER FOR APPLICANTS WITH CRIMINAL BACKGROUND CHECKS INITIATED THROUGH OTHER THAN SIUC

The following students wish to sit for the Illinois Nurse Aide Competency Exam at (Test Site Name) on (Scheduled Test Date).

Last
Name		 First
Name		 Middle
Initial		 Social
Security #		 Exam
Fee		 Exam
Date		 Program
Number		 CBC
Result		 CBC
Date
Anybody William P 000-00-0000 $25.00 05/03 0123 P 03/18/03
Doe Jane A 123-45-6789 $15.00 05/03 0123 C 07/23/02
Everybody William P 000-00-0001 $25.00 05/03 0123 NR 01/18/03
Public Sally Q 999-99-9999 $50.00 05/03 0123 MH 02/16/03
Somebody John D 987-65-4321 $50.00 05/03 0123 NRR 04/18/03

NOTE: P=Pending (ISP doing hand search),  C=Conviction,  NR=No Record,  MH=Multi-Hit, NRR=No Result Received

NOTE:  All rosters must follow the specified format as shown above.  Failure to supply the roster as outlined will result in the return of ALL applications to be corrected.  A separate roster must be completed for each separate test site or test date.