Pre-employment Testing Form

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The Commonwealth of Pennsylvania requires that the following testing be completed before a home care aide can be hired to work:

• 2-step TB test or equivalent (Quantum Gold or Chest x-ray is acceptable)
• Physical Exam
• Criminal background check
• FBI fingerprint check if the employee has not lived in Pennsylvania for two years
• Child abuse history clearance if the employee will be in contact with children

These tests are mandatory. The cost of testing will be deducted from your pay. The results are part of your personnel record, which means you are entitled to receive a copy of the test results upon request.

You may have these tests performed by your physician, which may cost you less money.

Pre-Employment Screening Costs
Item Cost
10-year Driver Record $11
PA Criminal Background Check $22
FBI Fingerprint (If necessary) $23.85
Child Abuse History Clearance $13.00
Physical Exam at My Doc $60
Physical Exam at St. Luke’s $72
TB testing at My Doc $50
TB testing at St. Luke’s $18 per step
QuantiFERON Gold My Doc $100
QuantiFERON Gold-St. Luke’s $99
Chest X-Ray at My Doc $100
Chest X-Ray at St. Luke’s $125
Mobile Health Physical $75
QuantiFERON Gold-Mobile Health $90

Your signature below indicates you were informed of this policy and agree to pay the costs of pre-employment screening by payroll deduction. Deductions not taken for any pay period may be carried over to a succeeding pay period and deducted accordingly. If you voluntarily resign or are terminated, any amounts due will be deducted from the final paycheck.

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