Pre-Employment Forms

Employee Health Services provides post offer pre-employment health screenings for all employees of UCDHS to satisfy the health clearance requirement prior to the start of work.   The documents used as a departmental request (appointment) form for the health clearance and the documents needed by the applicant can be found below.

Human Resources or Nurse Recruitment will schedule the employee health clearance. The schools of health coordinators will request a health screening for their applicants.

An hour should be allowed for this evaluation. The screening consists of a health history review, immunization review, labs and a TB screening test. Employee Health Services provides vaccines for Measles, Rubella, Mumps, Varicella and Tetanus/Diptheria/Tdap. Hepatitis B vaccination is mandatory for employees with patient care or researchers. Current medical center policy requires all employees to be immune to all diseases listed above.  Evidence of immunity is shown by documentation of appropriate receipt of vaccines or positive blood titers.  Employee Health will, as needed, provide blood titer testing and vaccines free of charge.

University non-paid visitors, observers, volunteer faculty will need to link to the outside clearance form below.  Individuals in this classification will need to obtain health clearance based on current medical center policy from their primary care provider at their own expense.  The completed form is maintained in the hosting departments’ files.

Please select a form below:

Employee Health Services Information Sheet pdf

New Hire Packet Forms 

Outside Clearance Form 

Clearance Requirement Form

School of Medicine Appointment Request Form

TES Appointment Request Form

Department Appointment Request Form