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CNA Background Checks: Everything You Need to Know

Hayley Harrison
May 22, 2024
8 min read

For employers in the healthcare industry, conducting background checks is often an essential part of the hiring process. If you need to fill a certified nursing assistant (CNA) position, performing background checks on candidates may help you to maintain a high standard of patient care, protect your reputation, retain grants and funding. Background checks may also be required to comply with federal, state, and local laws and regulations. 

Knowing about the background check process for CNAs will prepare you to perform pre-employment screenings that can help you make more informed hiring decisions. Here's what you need to know about CNA background checks.

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What is a CNA background check?

A CNA background check reviews public and private sources to obtain information about a candidate for a certified nursing assistant (CNA) position. Employers may perform this type of background check when hiring CNAs to work in long-term care facilities, continuing care facilities, hospitals, and other healthcare facilities. Background checks are also often a standard part of pre-employment screening for CNAs working as home health aides. 

Depending on employer policies and government regulations, healthcare background checks for CNAs may examine criminal history, education history, previous employment, professional licensure, driving history, and more. Screening may also include medical examinations and drug testing, in some cases.

Why should employers conduct CNA background checks?

Employers may wish to conduct CNA background checks for many reasons, including to confirm employment eligibility, protect patient safety, enable compliance and mitigate risk, improve patient outcomes, and maintain funding.

Confirm eligibility

Conducting a background check for CNA license status can confirm that a candidate is eligible to work as a certified nursing assistant. Many states require CNAs to obtain a license or certification from the state board of nursing, the department of public health, or a similar agency. A background check is a way to ensure that a candidate possesses the necessary license or certification, along with the necessary work experience, training, and skills to perform their assigned job duties.

Protect patient safety

Ensuring patients receive care in a safe environment is an essential responsibility for healthcare providers. A background check can help you determine if anything from a candidate’s history suggests they may pose a risk to patients, which is especially important for CNAs who work with vulnerable populations, such as senior citizens and individuals with disabilities. For CNAs in home health care, driving record checks can also help to promote public safety by enabling you to determine if a candidate has a safe driving history.

Comply with regulations

Where laws require background checks, healthcare employers must take steps to comply with regulations. For example, providers that receive federal healthcare funding may need to perform healthcare sanctions checks, such as Office of Inspector General (OIG) checks, before hiring candidates. These checks can determine if a candidate ever received sanctions for offenses like patient neglect and healthcare fraud. 

Laws may include penalties for non-compliance, and performing background checks can help employers avoid these penalties. When performing CRA background checks, employers must also comply with federal and state background check laws, including the Fair Credit Reporting Act (FCRA), as discussed below.

Improve patient outcomes

Performing background checks can give you confidence that a candidate is fully qualified for a CNA position and is therefore able to adhere to your organization’s standards of care. Maintaining your standards of care may help to improve patient outcomes and patient satisfaction rates. 

Maintain federal funding

Healthcare organizations that receive government grants must comply with laws and regulations, including those requiring background checks, to continue to benefit from funding. 

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CNA background check requirements

CNA background check requirements vary based on the rules and regulations established by state agencies and local health departments. They may include licensure status checks, criminal history checks, education and employment verification, drug testing, and medical screenings. In some cases, a healthcare sanctions check may be required to verify if a candidate appears on lists like the federal Office of Inspector General (OIG)’s List of Excluded Individuals/Entities (LEIE) and Fraud Abuse Control Information System (FACIS®) databases. 

Generally, background screening for CNAs is more in-depth than background checks in many other industries because certified nursing assistants often work with vulnerable populations. If you’re unsure of the requirements for CNA background checks in your area, you may wish to consult your legal counsel.

CNA background check laws

When performing a CNA background check, employers must comply with federal, state, and local laws. Here’s a review of some key laws that regulate the background check process.

Federal CNA background check laws

Federal CNA background check laws apply to healthcare employers in every state. They include:

    • The Fair Credit Reporting Act (FCRA) that requires employers working with a CRA to conduct background screenings to notify candidates of their intent to perform a background check. The law also mandates that employers obtain written consent before beginning the background check process and inform candidates of their right to review and correct information included in the report. In addition, the law establishes an adverse action process that employers must follow if they disqualify a candidate based on information included in a background check. 

    • The Equal Employment Opportunity Commission (EEOC) that enforces Title VII of the Civil Rights Act of 1964, which forbids employment discrimination based on race, sex, color, religion, or national origin. Today, the EEOC also enforces additional workplace discrimination laws that protect workers against discrimination based on pregnancy, gender identity, sexual orientation, age, disability, and genetic information. During the hiring process, employers are not allowed to  single out any protected classes for background checks. 

    • The Americans with Disabilities Act of 1990 (ADA) that prohibits employers from asking disability-related questions during the background check process or requiring medical examinations until after a conditional offer of employment. Under this law, employers are prohibited from discriminating against candidates with a history of substance abuse but are not currently using drugs, including those recovering from substance abuse and those currently enrolled in a rehabilitation program.

    • The Drug-free Workplace Act of 1988 that requires federal contractors and grantees to implement a drug-free workplace policy if they receive federal contracts of more than $100,000 or federal grants of any size. Employers, including healthcare organizations, regulated under the Drug-free Workplace Act must distribute a formal drug-free workplace policy statement, have a drug-free awareness program in place, and discipline employees who are convicted of criminal drug violations.

State CNA background check laws

Many states have state-specific requirements for CNA background checks that employers must comply with in addition to federal laws. A state can establish its own laws about which types of background checks an employer must conduct before hiring a candidate for a CNA position and specify what types of findings automatically disqualify candidates. These requirements may vary depending on the role and may also contrast with other states. Your legal counsel can help you determine what laws are applicable where you are hiring. 

Here’s a look at example requirements in a few states:

AlabamaAlabama Administrative Code establishes rules for mandatory pre-employment background in Chapter 34 of Title 13. The law requires anyone, including prospective CNAs, who will work directly with members of vulnerable populations, such as children or seniors, to undergo a criminal background check prior to employment.
IdahoIdaho Code § 56-1004A requires fingerprint-based background checks for CNAs working in long-term care facilities, home health agencies, or any position with direct patient access.
IllinoisThe Illinois Health Care Worker Background Check Act requires healthcare employers to conduct a criminal background check when hiring unlicensed candidates for CNA positions. It also regulates what types of criminal convictions automatically disqualify candidates from employment.
TexasTexas Health and Safety Code 250.006 prohibits individuals with a history of certain criminal convictions from working in healthcare professions, including as CNAs. It requires facilities to perform background checks prior to employment to determine if a candidate has any criminal history that would bar them from employment.

What information shows up on a CNA background check?

What shows up on a CNA background check depends on which screenings are run, compliance regulations in the candidate and the employer's location, and employer policies. A CNA background check may include a criminal background check, education verification, employment verification, professional license verification, healthcare sanctions checks, MVR checks, drug testing, and health screenings.

Criminal background check

    • National criminal records checks review thousands of databases to identify records that may require additional investigation. 

    • Federal criminal records checks search for records of convictions and pending cases at the federal level through the Public Access to Court Electronic Records (PACER) database. This type of check may return records of criminal offenses related to drug trafficking, fraud, and other federal crimes.

    • State criminal records checks look for records of felony and misdemeanor convictions, and other criminal records, at the state level. 

    • County criminal records checks search for criminal records at the county level, where most crimes are prosecuted.

    • Sex offender registry searches access sex offender registries for all 50 states, the District of Columbia, and US territories. Compliance regulations may require employers to disqualify candidates who appear on these registries from employment.

Education verification

An education verification confirms that a candidate’s education history matches the information provided on their application or resume. The verification can provide information about enrollment dates, the degrees or certificates awarded, and more. Performing an education verification can help determine whether a candidate has the necessary training to succeed in a CNA position.

Employment verification

An employment verification uses employment records to confirm the work experience listed on a candidate’s application or resume. The verification may include job titles and employment dates. As an employer, this screening can give you peace of mind that a candidate has relevant hands-on experience that can help them succeed in your open position. 

Professional license verification

A professional license verification confirms whether a candidate has an active CNA license or certification in a particular state. If your state requires professional licensing for CNAs, performing a verification can help you confirm that a candidate is eligible for employment.

Healthcare sanctions check

A healthcare sanctions check determines if a candidate has any previous exclusions, debarments, sanctions, and disciplinary actions. Compliance regulations may prohibit you from hiring individuals who have a history of these types of sanctions. 

A healthcare sanctions check searches primary sources like the List of Excluded Individuals/Entities (LEIE), published by the US Department of Health and Human Services Office of Inspector General and the System for Award Management (SAM), a database maintained by the US General Services Administration (GSA) which identifies individuals on the exclusion list for federal contracting opportunities. 

A Fraud and Abuse Control Information Systems (FACIS®) check is a more comprehensive type of healthcare sanctions check that may be required to satisfy state and federal regulations. There are four FACIS screening levels–1, 1M, 2, and 3–that search various primary sources and lists. More comprehensive search results are returned with each level, so employers may choose different search levels depending on the type of position being filled, the type of risk, and federal or state requirements for the screening. Checkr offers level 1M and level 3 screenings to help your organization meet state and federal requirements for healthcare background checks.

Driving record check

A motor vehicle record (MVR) check searches state-level driving history, such as license status and class, to determine the candidate’s eligibility for driving-related positions. You may wish to conduct an MVR check if your open position involves transporting patients or staff, delivering home medical equipment, or driving a company vehicle.  

Drug testing

Drug testing can detect the presence of illicit substances, certain prescription drugs, and alcohol in jurisdictions where testing is permitted. Conducting pre-employment or ongoing drug testing can help you adhere to your organization’s drug-free workplace policy. In some cases, requiring these drug tests may be necessary to comply with the federal Drug-free Workplace Act of 1988 and state or local laws.

Health screening

After extending an offer of employment, your organization may require a health screening and physical exam. This type of check can help you determine if a candidate is physically and mentally capable of performing their job duties. In some cases, medical screenings include testing for communicable diseases, such as tuberculosis (TB), and a review of vaccination history. 

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What disqualifies candidates from being a CNA?

What may disqualify a candidate from being hired as a CNA depends largely on employer policies and compliance regulations. In some cases, state laws provide a list of disqualifying convictions for CNA positions that employers must adhere to. Employers can identify additional CNA disqualifying offenses beyond those required by law, if they wish. Some information shown on a background check that might disqualify candidates include a lack of proper licensure, a history of healthcare sanctions, relevant criminal convictions, or a lack of required experience or education.

To avoid unintentional discrimination during the background check process, EEOC guidance recommends employers conduct the “nature-time-nature” test when the results of a background check return criminal history. This assessment helps employers consider the nature of the criminal offense, how long ago it occurred, and whether it’s relevant to the position in question.

How long does a CNA background check take?

How long a CNA background check takes depends largely on the scope of the check, the availability of records and whether you perform checks on your own or with the help of a background check provider, like Checkr. 

If you choose to perform the process on your own, each step will require an investment of labor and time. If you find that the records needed to perform a CNA background check are not available online, the process will take longer, as you'll need to contact agencies, employers, schools, and other organizations directly to gain access to records. In some cases, you may need to register with an organization or agency before using an online database, potentially leading to additional delays.

Using a background check company, like Checkr, may speed up the CNA background check process. Checkr’s modern platform delivers fast, accurate results with 89% of all criminal background check results available in under an hour, while customized adjudication filters help simplify compliance and streamline report reviews. Reduced manual tasks and increased accuracy helps your team complete CNA background screening checks faster and keep top candidates moving through your funnel.

How to conduct a CNA background check

To conduct a CNA background check, you can perform the process on your own or partner with an FCRA-certified background check provider. If you wish to conduct a check on your own, you will first need to gather information and obtain written permission from the candidate, which can be a time-consuming process. Then, you’ll search the necessary databases for each type of check you need to perform. In some cases, you may first need to register for or subscribe to a database service before accessing records online.

By partnering with a CRA, like Checkr, you can reduce costs and wait times associated with manual searches. Our advanced background check technology automates searching thousands of databases and prepares easy-to-read reports available through one centralized dashboard.

Working with a background check provider can also simplify communication with candidates throughout the CNA background check process. The Checkr candidate portal makes it easy for candidates to provide personal information, check the status of checks, and access multilingual live and chat support to keep the process moving quickly. The portal also allows candidates to check timelines and progress, creating an overall better experience.

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FAQs about CNA background checks

If you have additional questions about the CNA background check, these answers may help.

Can a candidate become a CNA with a felony conviction?

Whether a candidate can become a CNA with a felony conviction will depend on the nature of the offense, your organization’s background check policy, and compliance requirements. Your policies or government regulations may require you to automatically eliminate a candidate from consideration if a background check shows a previous felony conviction for certain CNA disqualifying offenses. Consult your legal counsel for advice about laws in your area.

Can a candidate become a CNA with a misdemeanor?

Whether a candidate can become a CNA with a misdemeanor depends on your organization’s background check policy. Your organization may identify specific misdemeanor convictions that preclude employment. Some states also prohibit employers from hiring candidates with criminal records for specific CNA disqualifying offenses. Your legal counsel may advise you on how to comply with laws in your area.

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Performing CNA background checks enables you to learn more about candidates’ criminal, education, work, and license history so that you can make more informed hiring decisions while complying with legal requirements. 

Checkr makes the process simpler, faster, and more accurate with streamlined workflows and advanced technology. We offer a full suite of screenings for CNA background checks, including criminal history, healthcare sanctions checks, and professional license verification. Plus, over 100+ ATS/HRIS integrations and flexible API let you seamlessly integrate Checkr into your existing tech stack. Get started with Checkr today.

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The resources and information provided here are for educational and informational purposes only and do not constitute legal advice. Always consult your own counsel for up-to-date legal advice and guidance related to your practices, needs, and compliance with applicable laws.

About the author

Hayley Harrison writes about a wide range of business topics and best practices, including background checks, candidate experience, and recruitment and retention. Her work includes educational articles, e-books, and blog posts.

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