Form 805 - Uniform Employment Application For Nurse Aide Staff (Page 2 of 7) in pdf

Form 805 - Uniform Employment Application For Nurse Aide Staff Page 2

Employer Instructions for Use – Uniform Employment Application for Nurse Aide Staff

§63-1-1950.1. Definitions - Criminal arrest check on certain persons offered employment -

Exemptions.

…………………………………………………………………………………………………

F. 1. If the results of a criminal history background check reveal that the subject person has been

convicted of, pled guilty or no contest to, or received a deferred sentence for any of the following

offenses, the employer shall not hire or contract with the person:

assault, battery, or assault and battery with a dangerous weapon,

aggravated assault and battery,

murder or attempted murder,

manslaughter, except involuntary manslaughter,

rape, incest or sodomy,

indecent exposure and indecent exhibition,

pandering,

child abuse,

abuse, neglect or financial exploitation of any person entrusted to the care or possession of

such person,

burglary in the first or second degree,

robbery in the first or second degree,

robbery or attempted robbery with a dangerous weapon, or imitation firearm,

arson in the first or second degree,

unlawful possession or distribution, or intent to distribute unlawfully, Schedule I through

V drugs as defined by the Uniform Controlled Dangerous Substances Act,

grand larceny, or

petit larceny or shoplifting within the past seven (7) years.

•

Information regarding ADA requirements

The employer will note there is no information requested on the ODH Form 805, Uniform Employment

Application for Nurse Aide Staff, pertaining to the Americans with Disabilities Act (ADA). However, it

should be noted that any qualified applicant with a disability may request reasonable accommodation(s) to

complete the application/interview process. The specific nature of the accommodation and the reason for

the request must be indicated at the time the application is requested. All other ADA requirements related

to the hiring process must be met according to the employer’s procedure and be in compliance with the

ADA.

Oklahoma State Department of Health

ODH Form 805

Protective Health Services

Revised 01/2011

Form 805 - Uniform Employment Application For Nurse Aide Staff Page 2