What Will You Become?
Iowa Western Community College

Records Check

 

Upon acceptance to Iowa Western's Health Programs (Practical Nursing, Associate Degree Nursing, Dental Hygiene, Dental Assisting, Medical Assisting, Emergency Medical Services and Surgical Technology), students are required to submit documentation of criminal history record reviews, Office of Inspector General/Health Human Services Medicare Exclusion check, and dependent adult and dependent child registry checks in the state of permanent residence and any state resided in during the past seven (7) years. All record checks are to include names used in the past seven (7) years unless otherwise requested. Choose your state of residence below:


Medicare Exclusion

Directions to complete the http://exclusions.oig.hhs.gov/ form

  • On the web page referred to below, type your name(s) in the spaces provided
  • Include any names used in the past 7 years
  • Click the search button and print the results
  • Turn in the printed results to your nursing director
Criminal Background Check

On the very bottom of the web page there are links to two forms:

Download and print the request form and EITHER the Billing Form/Fax Back form for mailing a check or for paying by credit card ($15).

Hints for completing the Request Form:
  • Ignore the account number and complete the rest of the information
  • The top right side is your return address information so that the DCI can return the data to you directly
  • The middle box, “Request, “ is where you write your identification information about yourself
  • The next box is the “results” section that the DCI will return to you stating whether or not you have a criminal history.  This is the proof that you will provide your school.  Please note you need a separate Form A for each last name you have had.  You do not need to sign the “Waiver” box because you are requesting this information of yourself.
  • Each last name submitted requires a separate Request Form with payment for each.
Hints for completing the Billing Forms:
  • Ignore the Account Number blank and complete the rest of the page until the very bottom
  • Put your last name on the first entry and ignore the remaining seven blanks
  • A completed Billing Form is required when submitting record check requests to the DCI.
  • Payment must be included unless a pre-paid account is established.
  • All pre-paid accounts must submit an Account Number.
  • Please check either Mail Back or Fax Back results; they will not do both.
  • Send a stamped, self-addressed envelope and 2 pages (Form A and your Billing Form) to the DCI with your payment. Within approximately 2-4 weeks you will receive a response from the DCI.  Turn in this report to the Director of Nursing
Abuse Registry Check

Directions for completing the forms:

Child Abuse Form
Adult Abuse Form

  • Find the section named Background Checks and then download and print the first two forms (Request for Child Abuse Information and Request for Dependent Adult Abuse Registry Information)
  • Complete these two forms and mail them to the address provided on the Request for Dependent Adult Abuse Registry form.
  • Hint for the Request for Child Abuse Information form:  Section I You-the student-are the requester.
  • Hint for the Request for Dependent Adult Abuse Registry information form:  Under “position and basis for authorization” write “student”
  • On receipt of the response from the state agencies, turn the originals in to the Director of Nursing.
Sex Offender Registry Check

http://www.nsopw.gov/core/Conditions.aspx?AspxAutoDetectCookieSupport=1

  • Scroll to bottom of page and click "I agree"
  • Enter the code that appears on the screen
  • Type in your name, please do separate report for each name you have used including maiden name if applicable.
  • Click "Search"
  • Print the screen that come up and turn in to the Director of Nursing
Medicare Exclusion

Directions to complete the http://exclusions.oig.hhs.gov/ form

  • On the web page referred to above, type your name(s) in the spaces provided
  • Include any names used in the past 7 years including maiden names
  • Click the search button and print the results
  • Turn in the printed results to your nursing director
  • There is no charge for this report
Nebraska Criminal Background Check

http://statepatrol.nebraska.gov/CriminalHistory.aspx

Print out this page: https://statepatrol.nebraska.gov/media/10246/criminal_history_request.pdf and fill in your information on the form and mail in with $15 fee.

Adult/Child Abuse Registry Check

Nebraska dependent adult/child abuse form

  • Complete this form, and return to Wendy Ziegler, she will fax it to DHHS.
  • There is no charge for this report
Sex Offender Registry Check

http://www.nsopw.gov/core/Conditions.aspx?AspxAutoDetectCookieSupport=1

  • Scroll to bottom of page and click "I agree"
  • Enter the code that appears on the screen
  • Type in your name, please do separate report for each name you have used including maiden name if applicable.
  • Click "Search"
  • Print the screen that come up and turn in to the Director of Nursing
Medicare Exclusion

Directions to complete this form: http://exclusions.oig.hhs.gov/

  • On the webpage referred to above, type your name(s) in the spaces provided.
  • Include any names used in the past 7 years including maiden names.
  • Click the search button and print the results.
  • Turn in the printed results to your nursing director.
Criminal Background Check & Adult/Child Abuse Registry Check

The form you need to complete to request both the background and abuse check is found on the Missouri State website at http://www.dhss.mo.gov/FCSR/AppsForms.html

  • Print the Worker Registration form.
  • Under Section A, check the box for "Voluntary Registrant".
  • Instructions for completing the rest of the form are included when you print it out.

On receipt of the response from the state agencies, turn the originals in to the Director of Nursing.

Sex Offender Registry Check

http://www.nsopw.gov/core/Conditions.aspx?AspxAutoDetectCookieSupport=1

  • Scroll to bottom of page and click "I agree"
  • Enter the code that appears on the screen
  • Type in your name, please do separate report for each name you have used including maiden name if applicable.
  • Click "Search"
  • Print the screen that come up and turn in to the Director of Nursing