Criminal Background & OIG Check Authorization

There is a potential that the resultant data will indicate an individual’s prior felony and/or misdemeanor convictions.  Prior convictions will be reviewed on a case-by-case basis, but some convictions are cause for immediate disqualification from Dignity Home Health Services LLC.

In connection with my service with Dignity Home Health Services LLC, I hereby authorize Dignity Home Health Services LLC to conduct a criminal background check on my behalf. I understand that this check will cover a search of law enforcement and court records and a check of the National Sex Offender Public Registry. I understand that my ability to serve as an employee/contractor with Dignity Home Health Services LLC is contingent upon the results of the background check. I understand that failure on my part to consent to the criminal background check will result in the revocation of any position offered to me or accepted by me. I acknowledge that the criminal background and National Sex Offender Public Registry checks may be shared with the Site Supervisor, the Governor’s Office of Community Service or the Corporation for National and Community Service if necessary. The member is entitled to receive and review the information obtained, upon request.

I certify that the information provided above is truthful and accurate to the best of my knowledge.  I understand that knowingly providing false information or omitting information may result in my disqualification or termination from Dignity Home Health Services LLC.