CNA Background Check Authorization Form Upload

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.

About You

Legal First Name	Legal Last Name
Email Address	Phone Number
Date of Birth MM/DD/YYYY	LLCC ID If you have one

Upload Completed Health Care Worker Background Check Form

Once we process the uploaded form, we will send you a Livescan document to take to an approved vendor for fingerprinting. The vendor will give you a receipt that you will need to return to LLCC via one of these methods:

LLCC Student Services Hub, Menard Hall, Springfield campus
LLCC Outreach Center (Jacksonville, Litchfield or Taylorville)
Email a copy to CNA.program@llcc.edu

Once the background check steps are completed and all required paperwork has been submitted to LLCC, you will receive an email confirming you have completed the background check requirement.