CNA Background Check Authorization Request

Complete this request to receive the Health Care Worker Background Check Authorization and Disclosure Form.

About You

Legal First Name	Legal Last Name
Date of Birth	Email Address
Phone Number	Approximately when do you plan on beginning the CNA class?

About the Background Check

A fingerprint-based criminal background check is required by law for all nurse assistant students and must be completed prior to registration. (Background checks from other LLCC Health Professions programs are not transferrable.) Please fill out the Health Care Worker Background Check Authorization and Disclosure Form legibly when you receive it.

Once you click submit, we’ll send you the form to the email you provided here. Please complete the form in that email and submit via the link (also provided in email).