As stipulated within clinical contracts, students enrolled in the Division of Nursing and Allied Health must conform to the rules, policies, and procedures of the clinical affiliates in order to participate in clinical learning experiences, which includes background checks. Failure to participate in clinical learning experiences for courses containing a clinical component results in failure of the course(s).
I. Licensure Implications
Students should refer to the Alabama Board of Nursing Administrative Code (www.abn.state.al.us) Chapters 610-X-4 and 610-X-8 and the General Catalog.
II. Guidelines Background checks will be conducted according to the following guidelines
• The General Catalog will provide reference to the background check policy.
The policy will also be posted on the Central Alabama Community College (CACC) website (www.cacc.edu) located by clicking on Academics under the navigation bar and then clicking on the Nursing Division submenu and within the Nursing Student Handbook. Beginning with the summer 2006 admission, students will receive the background check policy within the admission packet and will again received notice of the background check policy during
orientation. Beginning with the fall 2008 admission, students will also receive instructions for conducting the background check online prior to orientation.
• Students must sign the appropriate consent(s) prior to the background check.
A copy of the signed consent(s) will be maintained in the Division of Nursing and Allied Health office. Students will also be required to give consent online to the company conducting the background check. An individual failing to obtain a background check online by the designated company by the published deadline for the background check and/or refusing to sign the consent form will be prohibited from obtaining clinical learning experiences.
• The background checks will be scheduled and conducted by a designated company determined by the College. The designated company will be provided a copy of the policy. The student will be responsible for the cost of the background check. Results of the background check will be sent to the Director, Division of Nursing and Allied Health and to the student by the designated company.
• If a student fails to submit to the background check at the designated time, the student should contact the Division of Nursing and Allied Health in order to proceed with the background check. If the student fails to submit to the
background check as delineated, the student will be prohibited from obtaining clinical learning experiences. Failure to be able to obtain clinical learning experiences will result in a “F” for the course(s) if the student does not officially withdraw from the course(s).
• If the student has a positive background check and is not allowed by the clinical affiliate(s) to participate in clinical learning experiences, the student will receive a “F” for the course if the student does not officially
withdraw from the course(s).
• Any student denied clinical access by clinical affiliate(s) will be subject to dismissal from the program.
• If a student is unable to complete the clinical component of the course(s) that he/she is enrolled in due to a positive background check, the student will be advised regarding possible readmission.
• The background check may include, but is not limited to:
a. Criminal and Civil History/Records which reveals felony and
misdemeanor convictions, and pending cases usually including the date, nature of the offense, sentencing date, disposition, and current status.
b. Sex Offender which includes a search of the state or county repository for known sexual offenders.
c. Social Security Number Trace which is a verification that the number provided by the individual was issued by the Social Security
Administration, and is not listed in the files of the deceased.
d. Office of the Inspector General which identifies those individuals who have committed offenses deeming them ineligible to care for patients receiving Medicare benefits.
e. Employment and Education Verification f. Personal References/Interviews
g. Personal Credit History which is based on reports from any credit bureau.
h. Driving History including any traffic citations.
i. Present and Former Addresses j. Any Other Public Record
• The student with a positive background check will be informed of the results by the Director or the Assistant Director(s) of the Division of Nursing and Allied Health.
• Positive background checks will be reported to an individual at the respective clinical affiliate(s) that is specifically designated by the clinical affiliate(s), which often is the Director of Human Resources. This individual will be responsible for determining whether or not the individual will be allowed to obtain clinical learning experiences with the respective clinical affiliate(s) according to the rules, policies, and procedures of the clinical affiliate(s).
Students will sign consent(s) prior to disclosure of a positive background check to clinical affiliate(s).
• The student will be provided a copy of background check results. Any dispute of the accuracy of the background check must be submitted to the Director of
Nursing and Allied Health within seven (7) days of notification of receipt of the results.
• Background checks which could render a student ineligible to obtain clinical learning experiences include, but are not limited to, certain convictions or criminal charges which could jeopardize the health and safety of patients and sanctions or debarment. Felony or repeated misdemeanor activity within the past seven (7) years and Office of the Inspector General violations will
normally prohibit the obtainment of clinical learning experiences with clinical affiliate(s), but each positive background check will be reviewed individually.
III. Confidentiality
The Director or Assistant Director(s), Division of Nursing and Allied Health will review the background check results which will be maintained in a locked file in the Division of Nursing and Allied Health office. Confidentiality of the results will be maintained with only the Director or Assistant Director(s)of the Division of Nursing and Allied Health, the Dean of Instruction, President, or designee of the President and the student having access to the results with the exception of legal actions which require access to the results.
Approved Spring 06 Reviewed Spring 07
Reviewed and Revised Summer 08, Spring 2010
Central Alabama Community College Division of Nursing and Allied Health Background Check Consent and Release Form
I understand that Central Alabama Community College’s Division of Nursing and Allied Health programs have required clinical components. I also understand that since I must obtain clinical learning experiences with clinical affiliates, I must conform to rules, policies, and procedures of the clinical affiliates.
I also understand that prior to participation in the clinical learning experiences, I must submit to a Background Check by a company designated by the College. I further understand that if I have a positive Background Check and I am not allowed by the clinical affiliate(s) to participate in clinical learning experiences that I will receive a
“F” for the course if I do not officially withdraw from the course.
By signing this document, I am indicating that I have read, understand, and voluntarily and freely agree to the requirement to submit to a Background Check and to provide a negative Background Check prior to participation in clinical learning experiences.
A copy of this signed and dated document will constitute my consent for the company performing the background check to release the original results of my Background Check to Central Alabama Community College. I direct that the company hereby release the results to Central Alabama Community College. A copy of this signed and dated
document will constitute my consent for Central Alabama Community College to release the results of my background check to the clinical affiliate(s)’ specifically designated person. I direct that Central Alabama Community College hereby release the results to the respective clinical affiliate(s).
I further understand that my continued participation in Central Alabama Community College’s Division of Nursing and Allied Health programs is conditioned upon
satisfaction of the requirement of the Background Check, as well as other requirements, and satisfaction of the requirements of the clinical affiliate(s) providing clinical learning experiences for Central Alabama Community College’s Division of Nursing and Allied Health programs as it presently exists or as hereinafter required.
I agree to hold harmless the designated Background Check Company and its officers, agents, and employees; Central Alabama Community College and its officers, agents, and employees; and the clinical affiliate(s) and its officers, agents, and employees from and against any harm, claim, suit, or cause of action, which may occur as a direct or indirect result of the background check or release of the results to Central Alabama Community College and/or the clinical affiliates.
I understand that should any legal action be taken as a result of the Background Check, that confidentiality can no longer be maintained.
I have received and carefully read the Background Check policy and fully understand its contents. I agree to abide by the aforementioned policy. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone. I hereby authorize Central Alabama Community College and/or its contracted agents to procure a background check on me. I further understand this signed consent hereby authorizes Central Alabama Community College and/or its contracted agents to conduct necessary and/or periodic background checks as required by clinical affiliates.
Please answer the following questions:
1. Have you ever been convicted of a crime (misdemeanor or felony) or convicted in a military court martial? Yes_____ No_____
2. Have you ever been sanctioned or had your license suspended or revoked?
Yes_____ No_____
I certify that I have answered the above questions truthfully and that furnishing false information may subject me to formal disciplinary action.
__________________________________ _______________________________
Student Signature Witness Signature
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Student’s Printed Name Witness’ Printed Name
__________________________________ _______________________________
Parent’s/Legal Guardian’s Printed Name Parent’s/Legal Guardian’s Signature
__________________________________ ______________________________
Date Date