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COUNTY OF ORANGE

BACKGROUND VERIFICATIONGUIDE

MARCH 2011

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TABLE OF CONTENTS: What You Will Find in This Guide 3 What You Need to Know About Employment 4 and Education Verifications Getting Started: Questions to Ask Before Deciding 5-6 the Level of Background Check Examples of Background Verification Types 7

Employment Reference Check 7 Fingerprinting 8

Education and Accreditation Verification 9

Third-Party Agency Background Check 10

DMV Pull Notice 10

Drug and Alcohol Testing 11

The Work Number 11

Summary 12 Resources 13

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COUNTY OF ORANGE

BACKGROUND VERIFICATION GUIDE

What You Will Find In This Guide This background verification guide is intended to assist you, the Human Resources professional, in understanding: Types of background verifications The importance of conducting background verification checks, and Guidelines for how to determine which level of verification is appropriate when filling positions

in job classifications used throughout the County. The guide offers a menu of verification options. It also provides a sample resource list of professional organizations, web sites, and third party vendors specializing in background checks where specific verification types may be obtained for various classification levels.(See Attachment A – Professional Organizations, Web Sites and Third-Party Vendor List) Additionally, sample documents and process examples are included for easy reference. Keep in mind the list of resources included in this document for reference is not an all inclusive list. The County of Orange employs a workforce of over 17,000 individuals in approximately 1,000 job classifications. The level of verification checks conducted by County Human Resources personnel and hiring authorities varies based on the responsibilities and information access required of the particular job. The scope of background verification checks ranges from a basic employment reference check and fingerprinting to more in-depth background investigations conducted by the County’s law enforcement departments. To provide for the selection of the right people for job opportunities, employers often perform background and reference checks, pre-employment testing, and take other legally appropriate steps. The six most common fabrications from job applicants are: 1

1. Claiming a degree not earned 2. Diploma Mills or Fake Degree 3. Job Title 4. Dates of Employment 5. Compensation 6. Lack of Criminal Record

Employers should carefully review information provided by an applicant on their job application and/or résumé and pay close attention to any large gaps in employment, omissions or misstatements. Any “red flags” that may be identified would be handled on a case-by-case basis

1 Lester Rosen, President of Employment Screening Resources (ESR) Article Directory: http://www.articledashboard.com

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taking into consideration what the issue was and how it relates to the job. It is also critical for human resources personnel and hiring authorities to carefully consider the type of background verification based on the position responsibilities since background checks can create liability for the employer.

What you need to know about Employment and Education Verifications There really is no such a thing as a “typical” background or verification check. Verification scope (the elements that need to be verified) and depth (how many years back) should be carefully considered based on the job class, access to secure data and position responsibilities. It should also be determined which candidates will be investigated. For example, will it be the top two or three candidates or are all required to go through some level of background check? Will the appropriate verifications be conducted in-house or by an outside agency? You will need to evaluate if the employee has promoted or transferred to a position where there may be additional background information to verify. The initial threshold to consider when determining which level is appropriate, will be the minimum qualifications for the position and secondly to determine if there is a business necessity or nexus to the job to be filled. Consider if the position will require responsibilities such as public contact or access to confidential information. For example, you would not need to research driving record history for an Office Assistant who is assigned to a reception desk but you certainly need to for a Utility Worker/Driver or someone who handles money would require a fingerprint scan. While some departments require the minimum verifications such as a simple reference check, County law enforcement agencies are required to have their applicants complete a more in-depth rigorous background verification process for all of their positions. The process varies between departments and the depth is differentiated between sworn and non-sworn classifications. When Human Resources or the hiring authority is looking to conduct reference checks or other background verification checks, there must be some signed authorization from the applicant which ensures they are aware that a background check is being done prior to conducting a background check (See Attachment B – Sample of Applicant Release and Waiver). A waiver signed by the applicant provides protection to the employer and may eliminate or reduce the invasion of privacy risk. When a third party agency is to conduct a formal background check for example including credit, education, criminal, etc., they are required to have the applicant sign a waiver form too. Information typically required on the Applicant Release and Waiver is as follows: Name Address Telephone E-mail Driver’s License Number, State, Expiration The form must also give the applicant the option to obtain a copy of any search results conducted/copy of the credit report if a credit history to conducted.

NOTE: For peace officer positions, the form must be signed by the applicant and notarized

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The Agency/Department will notate that a background check was completed. Once hired, the documentation of when a background check was completed and the type of background conducted (Attachment G), along with the Applicant Release and Waiver (Attachment B), should be stored in OnBase in the employee’s “Sign-Up & Assignment” folder.

Getting Started: Questions to Ask Before Deciding the Level of Background Check Because background verifications are based on the position and the related responsibilities and access to secure or confidential information, it is required that some level of background check be performed for all applicants being considered in the final selection process for the position. This will ensure department practices are consistent to avoid discrimination claims. It is required that professional reference checks, fingerprinting (Live Scan), and any relevant education verifications/credentials if using to meet the minimum qualifications be completed as a baseline for all applicants considered for new hires. Employees who change assignments may require new or additional background verification checks depending on the requirements or duties of the new assignment. In order to determine the level of background check to be done at the pre-hire stage or when the employee has accepted a new assignment through a transfer or promotion, there are some questions you may want to ask yourself. The table below offers a reference point with a sampling of questions to consider with recommended background verification levels:

Questions to Consider Relative to the level of Background Verification

Pre-Employment Reference Check

The Work Number (Widely Used Vendor for Employment References)

Education/ Accreditation Verification

Live Scan In-Depth by Law Enforcement Agency or Third Party Vendor

DMV Print Out PULL NOTICE PROGRAM

Is the applicant new to County employment?

Yes Yes, if unable to do basic Reference Check and employer has an account

Yes, if required to meet minimum qualifications

Yes Depends on job class/duties

Depends on job class/duties

Is the applicant a current employee?

Check personnel file, review performance evaluations, contact previous supervisors

No Yes, if required to meet minimum qualifications




Is the applicant an intern or volunteer?



Yes, if the person will have access to confidential or sensitive information



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Questions to Consider Relative to the level of Background Verification

Pre-Employment Reference Check

The Work Number (Widely Used Vendor for Employment References)

Education/ Accreditation Verification

Live Scan In-Depth by Law Enforcement Agency or Third Party Vendor

DMV Print Out PULL NOTICE PROGRAM

Is the applicant a former County employee?

Yes, if the employee has been separated for more than 15 days

Yes, if unable to do basic Reference Check and employer has an account


Yes, if the employee has been separated for more than 15 days

Depends on job class/ duties


Does the classification/job require the employee to drive




Yes

Does the classification/job require the employee to handle cash or have access to confidential, financial or medical information?




No

Is the job in a non-sworn position in a criminal justice agency which requires a more in-depth background investigation?

Conducted during in-depth background process





Is the job in a sworn position in a criminal justice agency which requires a more extensive background investigation?






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Examples of Background Verification Types

Employment Reference Check

Today, more than ever, it’s difficult to get candid references from employers. That’s why it is important for you to seek as much reliable information as possible before hiring someone. There are various ways in which employment verifications may be obtained. It is required for all department human resources teams or hiring authorities (depending on departmental practices) to conduct a basic employment reference check. The number of references checked should be sufficient enough to depict the employees work history and level of competency. Most often, human resources teams and hiring authorities seek to verify dates of employment, title and responsibilities, salary, reason for leaving, eligibility for rehire, and education/accreditation verifications. This type of background verification will most often provide confirmation that what the employee has indicated on their application and in the interview for employment history is true. For County positions, the most basic and widely used form of employment verification is the “Reference Check Form”. This type of form is to be utilized by Departments before making a job offer. Included on the form are the employer’s name and name of the person conducting the reference check, dates of employment, and salary information for the applicant. Following the applicant information is a series of questions related to the applicant’s quality of work and interpersonal skills. Some Agency/Departments have developed their own reference check form. (See Attachment C - Reference Check Form Sample) Before conducting an employment reference check, key information should be obtained about the candidate through the job application and interview. Review the application to ensure that the applicant has provided the following: Dates of employment Positions held Job duties Beginning and ending rates of pay Names, telephone numbers and email addresses of references such as direct supervisors,

department heads, mentors, etc. If at the time human resources or the hiring authority cannot obtain a reference check with any of the references listed on the applicant’s job application or résumé, it is recommended that we attempt to verify dates of employment, position and salary through an agency called The Work Number. Many employers have an account with The Work Number and this will at least provide the minimum employment verification. See section below on The Work Number for more information. If the former employer does not utilize this vendor, it may be necessary to obtain another reference from the applicant. For former or current County employees who are being considered for re-hire or promotion, the hiring authority should review the three most recent performance evaluations and as a best practice, contact their previous or current supervisor. This will highlight for the hiring authority the work history and level of performance of the employee being considered. Any performance issues or other areas for concern should be taken into consideration at this time.

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Fingerprinting

Live Scan fingerprint screening is done through the Department of Justice. It is used to verify the criminal conviction information reported on the job application. All new hires and former employees should receive fingerprint screening. For transfers and reassignments, the screening may depend on the assignment. The following list may be used as an example in determining the need for a current criminal record check for an employee being promoted or transferred to a new assignment.

The employee: Has access to Protected Health Information (PHI). Has access to computer systems, networks or IT security that contain confidential

information. Handles cash, checks or other forms of payment and/or makes bank deposits. Has contact with vulnerable clients receiving services such as minors, mentally ill or the

elderly. Issues fees, fines, or business licenses. Provides services for which Medi-Cal may be billed. Makes decisions regarding contract bids.

Once the fingerprints are forwarded to the Department of Justice, they will notify the Human Resources Department of any criminal record information. Some County law enforcement agencies have access to the DOJ system to pull up the applicant’s Live Scan results. If your department does not have direct DOJ access, the Human Resources Department (HRD) will notify the HR Manager or designee of any criminal record results. If your applicant does come back with a “hit” you need to consider the following factors to determine the applicant’s eligibility for employment: Whether or not conviction(s) were listed on employment application Relationship between conviction and responsibility of position (Nexus) Time elapsed since conviction Frequency and severity of convictions

The County of Orange provides a process for fingerprinting applicants, employees, volunteers and interns through the utilization of fingerprint submissions.. Prior to employment, procedural requirements are as follows:

The applicable Department HR contact will provide the applicant or employee with contact information and the appropriate Live Scan form which can be obtain from the HR Portal

Applicant/current employee to schedule appointment with the Sheriff's Department. To schedule an appointment call (714) 834-6460.

Department HR completes Order Form BCII 8016 prior to the appointment (make three copies on the form) and provide completed forms to the applicant/current employee

Provide the completed forms and a valid photo identification card at the appointment time ○ Expired identification will not be accepted

Once fingerprinted, the applicant/current employee must return a copy of the form to his/her respective Department Human Resources contact

NOTE: Law Enforcement Agencies impose additional processes.

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DOJ will contact HRD with all results. When conviction results (“hits”) are received, HRD will directly contact the appropriate HR Manager or designee to share the findings. When clean results (no “hits”) are received, HRD will forward the findings to the appropriate agency/department HR designee. In the event of delays, HRD will monitor and ensure results are received and communicated. All findings will be considered confidential and will not be included in personnel documentation. Education and Accreditation Verification With regards to education verification, statistics show that more than half of all résumés contain exaggerated or fraudulent information concerning education.2 Education verifications are completed via telephone, fax, mail, and electronically through e-mail and Internet. During an education verification check, interviews are typically conducted with registrars’ offices. Human Resources teams and hiring authorities seek to verify dates of attendance, degrees, and major fields of study. This may include GED, high school diploma, college or advanced degrees. In addition, the school’s academic accreditation should be determined during each selection interview. The accreditation question may uncover fraudulent diploma mills and degree schemes. For some County of Orange job classifications, degrees, licenses, and earned credits are required to meet the minimum qualifications for the job. In many cases, credits earned may substitute for partial experience requirements. In these cases, it is mandatory for the recruiter or hiring authority to verify any earned credit towards required experience in meeting the minimum qualifications for the job. To expedite the process, you can inform candidates early in the recruitment process that they will be required to provide verification of their degrees/transcripts should they make the final selection. Professional license and certification verifications are always to be conducted for job classifications in the professional classification arena. These can include the name and address of the licensee; the licensing agency; license type, number, and class; status of license; and issue and expiration dates. As an example, the Health Care Agency screens applicants in the Pre-Job Offer Phase through multiple databases and the recruiter must complete a Candidate Pre-Hire Sanction and Credentialing Checklist. (See Attachment D – Candidate Pre-Hire Sanction and Credentialing Checklist) Although this form is specific to HCA’s divisions and classification types, you may want to consider adapting this same type of form for your agency/department needs. In determining whether or not an applicant’s degrees/course work or in some cases out of country degrees/coursework account for meeting minimum qualifications there are a couple of questions to consider: Is the degree required for the position?

Is the degree serving as an alternative to training and experience in order to meet the

minimum qualifications for the job? When it is determined that a degree or licensure is required for a particular job classification, the Human Resources team or hiring authority will need to establish a mechanism for verifying

2 National Diagnostics Inc. (NDI)

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education, accreditation or a specific degree. One example may be to obtain official transcripts, perhaps incorporating that requirement into the recruitment process, in which the applicant must provide them before they proceed to the final selection. In order to obtain out of country degrees and accreditation verifications this guide offers a couple of resources listed on the Professional Organizations and Websites resource list (Attachment A). Third Party Agency Background Check Another verification approach is to have an independent third-party vendor complete your employment verifications. There are many vendors which your department may want to explore. With a third-party vendor typically you can select the exact service or package of services that makes sense for your agency’s business and the specific position requirements. Through most vendors, services are billed to the Agency/Department responsible for utilization of their services. Most often, it is determined to use this type of vendor for executive level or high profile job classifications. The scope of background types varies from basic through extensive. If an employer hires an outside company to check your background, the applicant must be given a written notice and then provide consent as described above in Part 4. (CA Civil Code §1786.16) A screening company, called an investigative consumer reporting agency in the law, cannot go forward with the check unless the employer has certified that the report will only be used for a permissible employment purpose. If the applicant tells the employer s/he wants a copy of the report, s/he should get it within three days after the employer receives it. The report should also give the name, address, and telephone number of the person or agency that conducted the background check. Attached is an example of a list of background types through a third-party vendor. (See Attachment F – Sample List of Background Types by Third-Party Vendors). Use of Credit Reports CA Labor Code 1024.5 prohibits employers from utilizing a credit report in making a hiring decision unless the position is included as one of the acceptable positions outlined in the statute and the candidate is provided written notification that such a report may be obtained and the candidate provides their consent. What are the positions in which an employer may obtain a credit report? Employers may obtain a consumer credit report for employment purposes if the position involves at least one of the following: � A managerial position, as defined by 8CCR Section 11040 � A position in the state Department of Justice � A sworn peace officer or other law enforcement � A position for which the information contained in the report is required by law to be disclosed or obtained � A position that involves regular access to confidential information such as credit card account information, Social Security Number, AND Date of birth � A position which the person can enter into financial transactions on behalf of the company � A position that involves access to proprietary information � A position that involves regular access to cash totaling ten thousand dollars ($10,000) or more of the employer, a customer, or client, during the workday

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In addition, if the employer obtains the credit report for one of the permitted positions, it must also provide the consumer with the specific reasons why such a report will be collected and have a checkbox allowing the candidate to request a copy of the credit check free of charge. A requested report must be provided at the same time the employer receives its copy. DMV Pull Notice Program

The DMV Pull Notice system was established by the Department of Motor Vehicles to provide employers with a means of promoting driver safety through the ongoing review of driver records. The system is intended for both commercial and safety-sensitive drivers and employees who drive on a regular basis on behalf of the County.

The process for requesting a Department of Motor Vehicle Employee Pull Notice (EPN) report is for the HR team or hiring authority to request through the Human Resources Department (HRD) for the employee to be enrolled in the program. HRD completes the Enrollment of Drivers form. (See Attachment E – Government Employer Pull Notice). As an employer enrolled in the EPN Program, the County of Orange is assigned a requestor code. The requestor code is added to the employee’s driver license (DL) record. Note: The County’s requestor code is 67803. When an employee’s DL is updated to record an action/activity, a check is made electronically to determine if a pull notice is on file. If the action/activity is one that is specified to be reported under the EPN program, a driver’s record is generated and HRD will verify on the DMV web site.

Employee Pull Notice (EPN) Action/Activities Reports

The EPN program automatically generates a driver record when any of the following actions/activities occurs:

1. Upon enrollment of driver in the EPN program. 2. Annually from the date of enrollment or 12 months from the last action/activity printout. 3. When a driver has any of the following actions/activities added to his/her driver record:

Convictions

Failures to Appear

Accidents

Driver License Suspensions or Revocations

Any other actions taken against the driving privilege

If an employee’s status change (classification change, assignment change that eliminates county driving, employment separation, agency/department change, etc.) and they no longer operate or drive safety-sensitive vehicles, the employee must be removed from this system, as soon as practicable, by completing DMV Form INF 1103 (Attachment E) and send it to Human Resources Department (HRD).

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Drug and Alcohol Testing Pre-employment/transfer or promotion testing of job applicants for illegal drug use and alcohol is permitted for specified classifications only when there is a nexus to the job. Prior to the first time a covered employee performs safety-sensitive functions for the County, the employee will be tested for alcohol and controlled substances. Applicants for a safety-sensitive assignment will be tested for drug and alcohol misuse. When an applicant or employee transferring from a non-safety sensitive position into a safety-sensitive position fails an alcohol and/or drug test, the transfer will be revoked. Under the ADA, a test for illegal drugs and alcohol is not even considered a medical examination. Therefore, with the limitations, employers may test for illegal drugs before a pre-conditional offer is made. Importantly, if a drug test is performed before a conditional offer of employment is made, no other tests may be performed upon the applicant’s blood, urine, etc. While a drug test is not considered a medical examination, testing an applicant’s blood or urine for any other reason would constitute a medical examination and would likely be considered unlawful. We, therefore; recommend not requiring a drug and alcohol test until after the conditional offer, in order to do just one thorough and complete medical examination. The County shall conduct alcohol and drug testing as required by applicable law or regulations. The procedure for conducting alcohol and drug testing will be in strict conformance to Department of Transportation 49 CFR Part 40 and any other applicable DOT regulation. The County will adhere to all standards of confidentiality regarding employee testing. NOTE: For drug and alcohol testing of current employees, please seek guidance from the Human Resources Department. The Work Number The Work Number is a database that verifiers can use to verify employment and income information. The County utilizes this service as an employer either for verifying a potential candidate’s employment and income information or when employees need to provide proof of employment and income to an outside employer. The Work Number database can be accessed using either their website at http://www.TheWorkNumber.com or by calling 1-800-367-5690. The data on The Work Number database is provided by more than 1000 employers who contract with them. To find out if an employer uses The Work Number, you may access their web site and view the list of participating employers. To begin using The Work Number, you must first set up an account as a Verifier. In order to verify income of an employee, verifiers must obtain a Salary Key. Only the person whose information is being verified can create a salary key. For instructions on how the employee creates a salary key go to www.TheWorkNumber.com and click on Frequently Asked Questions (FAQs). When an agency/department chooses to use The Work Number to verify employment, they will be required to set up their own account and will be charged per verification.

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SUMMARY

With the County’s goal being to increase consistency in our application of determining when and how to conduct background verifications, please refer to this guide and the resources attached to assist you in your determination for the appropriate level of verification.

When considering job offers to applicants for all Countywide classifications, departments will need to conduct at least a basic reference check which includes fingerprinting (Live Scan), employment-checking and educational/credentials verification, when required to meet the minimum qualifications of the position he or she is applying for. There may be occasions when there is an urgency to fill the position that an offer contingent upon background clearance may be extended. In these cases, make sure this language is clearly stated and included as a part of the offer. Additional checks and scope as mentioned earlier in this guide will ultimately be determined by the job classification, minimum requirements, and nexus to the job.

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Attachment A Professional Organizations, Web sites and Third-Party Vendor List Association of Social Work Boards: http://www.aswb.org/SWL/swregistry.asp Board of Registered Nursing: http://www.rn.ca.gov/ Board of Vocational Nursing and Psychiatric Technicians: http://www.bvnpt.ca.gov/license_verification.shtml Council for Higher Education - (Education Degrees and Accreditation both U.S. and International): www.CHEA.org

Department of Education Data Base for Postsecondary Institutions and Programs - http://ope.ed.gov/accreditation/ Employers wishing to verify foreign degrees and credentialing, may contact NACES for a list of companies providing this service at: www.naces.org/members.htm National Practitioner Data Bank - A national database maintained by the Department of Health and Human Services of physicians and dentists who have been subject to discipline based on malpractice or other unethical conduct related to their licensure. http://www.npdb-hipdb.hrsa.gov/ Society of Human Resources Management (SHRM) - SHRM provides resources, global best practices and employment updates and laws: http://www.shrm.org/LegalIssues/EmploymentLawAreas/Pages/default.aspx Attachment A (cont.) The State Bar of California - (Attorney Search) http://members.calbar.ca.gov/search/member.aspx UNESCO http://www.unesco.org/iau/ - International Handbook of Universities – (Annual publication containing international institutions of higher education that are deemed equivalent to that of U.S. based institutions. This publication is available at Cal State University Fullerton library

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Local Third Party Agencies

Accurate Background, Inc. - [email protected]

AccuSource - [email protected] Corra Group – [email protected] Local Third Party Agencies Data Check - http://www.datacheckinc.com/contact.php Employee Relations Inc. - http://www.employeerelations.com HireRight - http://www.hireright.com/Background-Checks.aspx?apsi=0#Offerings Kroll - http://www.krollbackgroundscreening.com/comprehensive-services/ The Work Number - http://www.theworknumber.com/index.asp

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County of Orange

Attachment B

APPLICANT RELEASE AND WAIVER

TO WHOM IT MAY CONCERN: I hereby authorize any representative of the COUNTY OF ORANGE, bearing this release, or a copy of it, the right to conduct an investigation of my background. I understand that the investigation may include inquiry into my past employment, education, and activities, including, but not limited to, credit, criminal background information and driving record, and I release from all liability all persons, companies, schools, and corporations supplying such information. To the extent permitted by law, I indemnify you against any liability which might result from making such investigation. Additionally, I agree that you may obtain an investigative consumer report, or other information, regarding me and may consult certain files which are available. I understand that, to the extent required by law, the COUNTY OF ORANGE will retain the results of this investigation and a copy of my application for employment. I understand that any false answers or statements, or misrepresentations by omission, made by me on this application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered after I am employed. I understand that you may contact my previous employers and I authorize those employers to disclose to you all records pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, to the extent permitted by law, I hereby fully waive any rights or claims I have, or may have, against my former employers, their agents, employees, and representatives, as well as other individuals who release information to you, and release them from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of such information by any person or party, whether such information is favorable or unfavorable to me. I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s right will be provided to me. Signature of applicant Date Full name of applicant (PRINT)

Print All Former Names Used

Specify reason for credit report if credit report is obtained: _____________________________________

Source of credit report: _________________________________

I would like a free copy of my credit report if my credit report is obtained for employment purposes.

Address, City and State Zip Code Driver’s License Number State: Expiration: / /______

Expiration Date: (Up to One Year)

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Attachment C

COUNTY OF ORANGE AGENCY/ DEPARTMENT TELEPHONE REFERENCE CHECK (SAMPLE)

APPLICANT NAME:

TITLE OF POSITION:

Date: CURRENT/LAST SALARY:

ORGANIZATION CONTACTED: DATES OF EMPLOYMENT:

NAME AND TITLE OF PERSON CONTACTED: NAME AND TITLE OF PERSON COMPLETING CHECK:

[QUESTIONS TO ASK FORMER EMPLOYER - ONE (1) BEING UNACCEPTABLE, THREE (3) BEING STANDARD, AND FIVE (5) BEING OUTSTANDING. Write additional comments under explanation.] 1. Have you verified that has a degree? Yes No N/A 2. Have you verified that is license as a ? Yes No N/A 3. How is/was ‘s punctuality in arriving to work and/or scheduled meetings? 1 3 5 Explanation: 4. How is/was 's attendance record? 1 3 5 Explanation: 5. How is/was 's record of completion assignments within established deadlines? 1 3 5 Explanation: 6. How is/was 's level of quality in completing of assignments? 1 3 5 Explanation: 7. How is/was 's ability to function independently with little or no supervision in completing the

assignments? 1 3 5 Explanation: 8. How is/was 's enthusiasm or response attitude toward accepting assignments? 1 3 5 Explanation:

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Attachment C (Cont.) 9. How is/was 's

initiative in handling assignments such as? A. Following through without reminders 1 3 5

Explanation: B. Anticipating problem areas. 1 3 5 Explanation: 10. How is/was 's attitude demonstrated toward the job in general? 1 3 5 Explanation: 11. How is/was 's ability to get along with: A. Other staff 1 3 5 Explanation: B. Community groups, clients, etc, Supervision 1 3 5 Explanation: 12. How is/was 's responsiveness to direction/constructive criticism? 1 3 5 Explanation: 13. How is/was 's effectiveness in a supervisory/managerial capacity? 1 3 5 Explanation: 14. What are/were 's greatest strengths and areas needing further development? 1 3 5 Explanation: 15. What is/was 's reason for leaving? 1 3 5 Explanation: 16. Would you rehire? Yes No Explanation: 17. Typing speed ( ) N/A Dictation speed ( ) N/A

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( if applicable ) ( if applicable ) 18. Additional questions specific to position: Approval:

Supervisor

Program Manager

Division Manager/Asst. Director

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Attachment D

Candidate Pre-Hire Credentialing and Sanctioning Checklist (SAMPLE) Candidate's Name: SSN:

Job Class: ORG

Instructions: Circle Yes or No to the required questions. If you get a Yes to any of the questions; put job offer on hold; tell candidate you will call them back; and notify ER Analyst.

COMPLETE FOR EVERY EMPLOYEE (Print Screens)

Federal Sanction Information: Problem?ER Analyst

Excluded Provider http://www.epls.gov/index.html Yes No ______ Excluded Prov. Federal http://exclusions.oig.hhs.gov/ Yes No ______

Medi-Cal Search: Yes No ______

National Practitioner Data Base www.npdbhipdb.com (Physicians and Dentists only) Yes No ______

Application reviewed for convictions:

Any convictions? Yes No ______ Will the conviction be a problem? Check with ER Analyst Yes No ______

Verification of license, registration, or required letters:

Licensed Verified: Yes No License #: (copy the webpage)

Registration Verified: Yes No License #: (copy the webpage)

Letter Verified: Yes No Date: (copy placed in job offer packet)

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Attachment D (cont.) Instructions: If no problems identified above, ask the following questions.

The Health Care Agency is required to ensure that all new employees are not designated as "Ineligible Persons" by a federal or state law enforcement, regulatory, or licensing agency because we receive Federal funds. I now have 3 questions to ask you.

1. Have you ever been convicted of, or are you currently being prosecuted for a crime related to healthcare?

No If yes, please explain.

2. Have you ever been or are you now excluded, suspended, debarred or otherwise ineligible to participate

in federal health care programs?


3. Are you currently under investigation for activity that could result in your ineligibility to participate

in the Federal health care programs?


BEHAVIORAL & PUBLIC HEALTH SERVICES ONLY

COMPLETE FOR: CSW, MFT, CLINICAL PSYCH, PSYCH/MD, NURSE (RN) & PSYCH TECH Medicare Information: Problem?

ER Analyst

Opted Out (LCSW, CP2, MD, PA/NP) 4. Have you ever Opted Out of Medicare billing? Yes No ______

Reminder: If you received a Yes to any of the above questions; put job offer on hold and notify ER Analyst. OK to Hire, no problems with license, no convictions, and was not listed on any website.DO NOT Hire, problem(s) were identified. This information was screened by: _________________________ on ______________

verified by: _________________________ on ______________

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Attachment F Sample List of Background Types by Third-Party Vendors

a) Criminal Records check

b) Sex Offender Registry check

c) Civil Records check

d) Social Security Number verification (including addresses/phone numbers associated with (SSN)

e) Motor Vehicle Records check

f) Education/degree verification

g) Professional License check

h) Check of special licenses/certifications; including sanctions taken or pending

i) Professional reference checks:

j) Credit check

k) Drug testing

l) California Civil Code 1786 Compliance

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Attachment G

Background Verification Checklist Applicant’s Name:________________________ Date: ________________ Position Applied For:________________________________Dept/Agency: ____________

Comments/Concerns: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Completed by: _____________________________ Date: ____________ PRINT NAME _____________________________ Title

Type of Background Verification Completed: □ LiveScan (Fingerprinting) Date Completed: ___________ □ Professional References Date Completed: ___________ □ Educational Accreditation Date Completed: ___________ Provide specifics on what was verified: _________________________________________________________________ □ DMV Pull Notice Date Completed: ___________ □ Other: ____________________ Date Completed: ___________ Specify:__________________________________________________________

If hired, scan only this document (without any supporting documentation) into OnBase and store in the employee’s personnel file under “Sign-ups & Assignment Records.”

background verification guidebos.ocgov.com/hr/.../docs2/docs_pol_proc_memos/background_verifi… ·...

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