Healthcare Request Form

Healthcare Request Form Pursuant to KRS 216.787 – Multiple Inquiry Form

This form may only be used by organizations required to screen applicants for employment under KRS 216.787 providing healthcare services. Any other use is prohibited.

ORGANIZATION: Sansbury Care Center
ADDRESS: 2625 Bardstown Road
CITY/ZIP: St. Catharine, KY 40061
PHONE: 859-336-3974
CATEGORY: HC
CUSTOMER ID: 2641
CONTACT: Carol Morgeson, HR Director
EMAIL: cmorgeson@sansburycare.org
FAX: 859-336-9987 (CONFIDENTIAL)

If you have any questions, please contact Pretrial Records at 800-928-6381 or 573-1682. The address is Administrative Office of the Courts, Pretrial Services, Records, 100 Millcreek Park, Frankfort, KY 40601.

Authorization for Pre-Employment Check
Street, City, State/Zip