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Health Department Criminal Background Check Authorization

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  2. Notification and Authorization to Conduct Criminal Background Checks at the Lenawee County Health Department (LCHD)

    Grant funding requires the LCHD to conduct a criminal background check for each employee, subcontractor, subcontractor employee, intern, or volunteer who works directly with clients or has access to client information. This check will be conducted by the LCHD, and is inclusive of both misdemeanor and felony convictions. The criminal background check includes the following;

  4. • Internet Criminal History Access Tool (ICHAT)
  6. • Michigan Public Sex Offender Registry
  8. • National Sex Offender Registry
  10. A check of the Central Registry will be conducted for each employee, subcontractor, subcontractor employee, intern, or volunteer who works directly with children or vulnerable adults.
  12. I understand that a positive ICHAT or Central Registry response, reported felony conviction or perpetrator identification, may affect my eligibility for hire.
  14. I am aware that I must notify the LCHD in writing of criminal convictions (felony or misdemeanor), pending felony charges, or placement on the Central Registry as a perpetrator, at hire or within 10 days of the event after hire.
  16. I hereby authorize the LCHD to conduct the criminal background check described above, and annually thereafter, after hire.
  18. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your document will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  30. This field is not part of the form submission.