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Health Occupations Student Checklist


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									                             Health Occupations Student Checklist
Name: (PRINT)                                       _______________________

                                                                                                 PROGRAM (check one)
LSC ID#:                                            SSN:            _________
                                                                                                           Certified Nurse Aide
   All Programs File Documents/Requirements
        rograms:                                                                                           Medication Aide
                                                                                                           Electrocardiography Tech
    o      At least 18 yrs. old    o Student Handbook Pages                                                Phlebotomy
    o      Copy of S.S. Card                Application for Admission Form                                 Hemodialysis Technician
    o      Copy of TX DL or ID              Handbook Acknowledgment                                        Patient Care Technician
    o      Background Check                 Americans with Disabilities Act Form                           Personal Trainer
    o      Paid Tuition                     Confidentiality Agreement
                                            Release of Liability
                                            Authorization to Release Ed Records

  Specific Programs: Additional File Documents/Requirements
    Certified Nurse Aide Program                                                        Medication Aide Program
        o Immunizations                                                  o Notarized HS Diploma or GED copy
                 Hepatitis B (3 shots)/TITER                             o Immunizations
                              Tdap (last 10 years)                                 Hepatitis B (3 shots)/TITER
                              MMR (2)                                                             Tdap (last 10 years)
                              Varicella (2)/TITER                                                 MMR (2)
                              TB Skin Test Negative (within 1 yr)                                 Varicella (2)/TITER
        o NACES Application                                                                       TB Skin Test Negative (within 1 yr)
        o NACES Exam Money Order $93.00                                  o Holds CNA Certificate OR Employed for at least
        o Sanctions Review Passed                                          90 days in a nursing home, MHMRA or TJDCJ
                                                                         o Notarized DADS forms (3)
                                                                                        Experience Doc Report (1 pg.)
                                                                                        DADS Enrollment form (2 pgs.)
    Electrocardiography Technician Program                               o DADS Money Order $25.00
        o High School Diploma or GED copy                                  Note: Background check can be provided by employer
        o Immunizations                                                         or LSC vendor. If student has only 1 misdemeanor, he/she
                  Hepatitis B (3 shots)/TITER                                   must complete a Felony/Misdemeanor Evaluation Form.
                                                                                Students with a felony or multiple offenses cannot
                  Tdap (last 10 years)
                                                                                participate in the Med Aide program.
                  MMR (2)
                  Varicella (2)/TITER
                  TB Skin Test Negative (within 1 yr)
        o Valid American Heart Association CPR cert
          for health occupations                                       Phlebotomy Program
        o ACA Application                                                o High School Diploma or GED copy
        o ACA Money Order $100.00                                        o Immunizations
                                                                                    Hepatitis B (3 shots)/TITER
                                                                                    Tdap (last 10 years)
                                                                                    MMR (2)
                                                                                    Varicella (2)/TITER
                                                                                    TB Skin Test Negative (within 1 yr)
                                                                         o Valid American Heart Association CPR cert for
                                                                           health occupations
Patient Care Technician (PCT) Program             Hemodialysis Program
                                                  o   High School Diploma or GED copy
o High School Diploma or GED copy
                                                  o   Immunizations
o Immunizations
                                                           Hepatitis B (3 shots)/TITER
            Hepatitis B (3 shots)/TITER
                                                           Tdap (last 10 years)
            Tdap (last 10 years)
                                                           MMR (2)
            MMR (2)
                                                           Varicella (2)/TITER
            Varicella (2)/TITER
                                                           TB Skin Test Negative (w/n 1 yr)
            TB Skin Test Negative (w/n 1 yr)
o Valid American Heart Association CPR cert for   o   PCT Certificate/LVN certificate/Medical Asst.
                                                  o   Valid American Heart Association CPR cert
  health occupations
o MUST complete all requirements for Certified        for health occupations
  Nurse Aide, Electrocardiography (except exam
  and money order), and Phlebotomy (See other
  side and check boxes.)

Scrubs Color by Program:
Certified Nurse Aide -PURPLE
Phlebotomy - RED
Electrocardiography- BLUE
                                LSCS Health Occupation Programs
                                Instructions for Background Check Process

Prior to registering for many healthcare programs, students who have been conditionally accepted must
complete a criminal background check. Students are responsible for completing the background
application process, paying all fees and ensuring that a copy is submitted to the appropriate program
director. Additional background checks may be required, if a student is convicted of a felony or
misdemeanor while enrolled in a LSCS healthcare program. The four (4) background check agencies that
are accepted by LSCS are listed alphabetically below.

Clinical facilities determine what constitutes an unacceptable background check. The student is
responsible for working with the background check company to clear up any reporting discrepancies. If
there is a criminal history that cannot be cleared up prior to the start of clinical, the student needs to apply
to his/her respective professional board for licensure clearance. Students cannot begin or continue their
studies until the background check process is satisfactorily completed.


Standard Student Package Code: NO30
Price: $35.00* (Please note the package code consists of the letters N, O and the numbers 3, 0).

International Student Package Code: NO30A
Price: $45.00* (Please note the package code consists of the letters N, O, the numbers 3, 0 and the letter A)

Access application online at http://www.certifiedbackground.com Applicants complete the release
information form and select payment type-- a password is then generated and the applicant shares it with
the program director to view the reported results.

MYBACKGROUNDCHECK.COM             $44.95

Access application on line @ http://www.MyBackgroundCheck.com

3 ways to order:

    1. Fax application to 800-503-2371 (requires credit card)
    2. Mail in money order or certified check to MyBackgroundCheck.com, P.O. Box 492770, Redding, CA
    3. Online Application (requires credit card) @ http://www.MyBackgroundCheck.com enter Order Code
       (A4P25) and click on the → and follow the instructions. The Certificate of Verification is emailed to
       the applicant and available online for 90 days.
PreCheck, Inc.~ StudentCheck Package: $45.00 (flat rate)

   Go to www.PreCheck.com and click on the StudentCheck link to fill out an application.

   Select your campus and program.

   Payments can be made securely online with a credit/debit card or money order. Paying with money
   order will delay processing your background check until the money order is received by mail at the
   Precheck office.

   For your records, you will be provided a receipt and confirmation page for your order.

   PreCheck will not use your information for any other purposes other than a background check. Your
   credit will not be investigation and your name will not be given out to any businesses.

   If you need assistance, please contact PreCheck at StudentCheck@PreCheck.com.


Please go to: www.ResearchInfoGroup.com/lonestar to submit your order or ask any questions.

Click on “Order Now” then complete the application and submit your application.

Payment options will then be provided. Safe and secure payment methods via either traditional bank/credit
card or via Pay Pal accepted.

The company operates out of Houston, Texas and will reply within 1 business day to all inquiries.

No log-in or password required.


Access application online @ https://client.verifiedcredentials.com/LSCS

Follow prompts to your specific program and follow directions for ordering the report.

Payment may be made by credit card, debit card or bank transfer online. A money order is also
acceptable, but will delay the process. Reports will not be submitted until payment is received. Mail to:
Verified Credentials/Student, 20890 Kenbridge Court, Lakeville, MN 55044. For assistance, if problems
are encountered, please contact: Verified Credentials at 800-938-6090.

Report includes:

               ST-Criminal Texas
               ST-Sex Offender Index
               Patriot Act
               Social Security Alert
               NW-Healthcare Fraud & Abuse

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