WORK HISTORY: LIST MOST RECENT EMPLOYER FIRST, INCLUDE PART-TIME EMPLOYMENT
It is mandatory that all applicants be registered with the Missouri Department of Health and Senior Services' Family Care Safety Registry. My signature below provides authorization for Be Intentional Home Health Care, LLC to conduct a background screening on me. If I am not registered I will pay the Fourteen dollars ($14.00) and ($1.25) on dollar and twenty cent online registration fee or my paper registration can be mailed with a fee of fourteen dollars ($14.00). If there are findings in my screening, and I want to become an employee, I agree to complete "Good Cause Waiver" application prior to being hired by Be Intentional Home Health Care, LLC. Once complete, Be Intentional Home Health Care, LLC will receive a report from the Family Registry indicating a Good Cause Waiver has been received and a case opened on my behalf. The Department of Health and Senior Services may grant (approve) a "Good Cause Waiver" at their discretion. Be Intentional Home Health Care, LLC will not hire any attendant needing a "Good Cause Waiver" until the waiver is approved, no exceptions.
The FCSR will be checked prior to hire and annually after hired.
Be Intentional Home Health Care, LLC is required by the Department of Homeland Security to verify employment eligibility for all newly hired employees regardless of citizenship.
The Employee Disqualification List (EDL) maintained by the Department of Health and Senior Services is a listing of individuals who have been determined to have: Abused or neglected a resident, patient, client, or consumer; misappropriated funds or property belonging to a resident, patient, client, or consumer; of falsified documentation verifying delivery of services to an in-home services client or consure. The EDL will be checked four times per year.
The OIG will be checked monthly.
No applicant can be employed by Be Intentional Home Health Care, LLC, until they pass a screening of the Employee Disqualifications List (EDL) and until Be Intentional Home Health Care, LLC has obtained a background check on the applicant from the Family Care Safety Registry (FCSR). Anyone listed on the EDL will not, under any circumstances, be employed by Be Intentional Home Health Care, LLC. If hired, the attendant will have a copy of the background check, OIG and EDL placed in their application file. If any new listing appear on either of these background checks, the attendant will no longer be able to be employed by Be Intentional Home Health Care, LLC.
BACKGROUND SCREENING APPLICATION