You have been hired to work in an area of Regions Hospital that is licensed by the Minnesota Department of Human Services (DHS). As an individual that may have direct patient contact in your role, we are required to initiate a background study though DHS to remain compliant with licensing. Please fill out the information below:
IMPORTANT: The information listed below must match the identification you provide to be fingerprinted otherwise you will not be able to be fingerprinted. 

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* 1. PERSONAL INFORMATION

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* 2. Date of Birth (Month/Day/Year)

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* 8. Weight (lbs)

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i We adjusted the number you entered based on the slider’s scale.

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* 9. Drivers License, State ID or Passport Number

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* 11. New Job Title

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* 12. Facility

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