Quick Answer

Yes, Duke Health does hire individuals with felony convictions for certain positions. As one of the Southeast's premier academic health systems with approximately 26,278 full-time employees across Duke University Health System, employment decisions are conditional upon passing a comprehensive background check and are subject to Fair Chance Hiring principles and EEOC guidelines. Duke adopted Ban the Box policies in 2018, removing criminal history questions from initial job applications.

The law prohibits companies from having a blanket policy excluding all felons. Instead, they must conduct an individualized assessment of the conviction to determine if it is job-related and consistent with business necessity.

The greatest barriers are created by felonies related to healthcare fraud (permanent OIG exclusion), patient abuse or neglect (mandatory exclusion from federal healthcare programs), and controlled substance offenses (exclusion from positions with medication access). Recent offenses within the past 7 years face the highest scrutiny regardless of type.

The best entry points are Environmental Services, Food Services, Patient Transport, and Facilities/Maintenance positions, which offer pathways to employment for individuals with criminal records while avoiding the most restrictive regulatory barriers associated with direct patient care and medication access.

Table of Content

1. Quick Answer

2. Felon-Friendly Scorecard

3. Eligibility Checklist

4. Critical Regulatory Information

5. Company Overview

6. Hiring Policy Analysis

7. Background Check Process

8. Application Strategy

9. Tips for Applicants with Records

10. Benefits Overview

11. Frequently Asked Questions

12. Alternative Second Chance Employers

13. Conclusion

14. Disclaimer

Felon-Friendly Scorecard

Eligibility Checklist

Before applying, honestly assess whether you meet these baseline requirements:

• No OIG Exclusion: Must verify you are NOT on the Office of Inspector General's List of Excluded Individuals/Entities (LEIE). Search at oig.hhs.gov/exclusions before applying. Exclusion is a permanent legal bar from healthcare employment.

  
  

• No Blanket Exclusion: Must be aware that Duke Health is not allowed to automatically exclude you solely for being a felon. EEOC guidelines require individualized assessment of your conviction's job-relatedness.

  
  

• Job-Related Assessment: Must be prepared for Duke Health to evaluate whether your felony is related to the job duties using the Green Factors: nature of crime, time elapsed, and nature of job sought.

  
  

• Physical Requirements: Many positions require standing for extended periods, lifting up to 50 pounds, and working in a fast-paced healthcare environment. Physical capacity testing may be required for certain roles.

  
  

• Drug Screen: Must pass a mandatory pre-employment drug test. All Duke University Health System staff are screened for illegal drugs via urine testing. Positive results rescind conditional offers; not eligible to reapply for one year.

  
  

• Honesty is Paramount: Must be completely honest about your criminal record when asked (after conditional offer). Lying is an automatic disqualifier and can result in termination if discovered later. Duke conducts thorough background checks via HireRight.

  
  

• Work Authorization: Must be legally authorized to work in the United States and able to provide required I-9 documentation.

  
  

• Health Requirements: Must complete pre-placement health review through Employee Occupational Health & Wellness, including proof of immunity to communicable diseases and annual flu vaccination.

Critical Regulatory Information

Understanding the legal landscape for criminal records in healthcare employment is essential for Second Chance applicants. Duke Health must comply with federal OIG regulations, North Carolina state laws, and EEOC guidelines. North Carolina adopted Ban the Box for state agencies in 2020, and Duke voluntarily removed criminal history questions from applications in 2018.

EEOC Guidelines

The Equal Employment Opportunity Commission advises employers not to automatically refuse to consider an applicant because of a criminal record. Employers must conduct an individualized assessment considering the Green Factors:

(1) Nature and gravity of the offense;

(2) Time elapsed since the offense and/or completion of sentence;

(3) Nature of the job sought and its relationship to the offense. Blanket policies excluding all felons are prohibited. Duke's policy specifically considers the crime's severity, recency, and most importantly, job relatedness.

FCRA Requirements

Duke Health uses HireRight, a third-party consumer reporting agency, to conduct background checks. Under the Fair Credit Reporting Act (FCRA), Duke must:

(1) Provide written notice and obtain written consent before conducting the check; (2) Provide pre-adverse action notice with a copy of the report and summary of FCRA rights if considering denial;

(3) Allow reasonable time to dispute inaccuracies before making final decision;

(4) Provide final adverse action notice if decision stands after review.

State-Specific Considerations

North Carolina has moderate Fair Chance protections. Executive Order 158 (effective November 2020) implements Ban the Box for state agencies, prohibiting criminal history questions until after the initial interview. While this executive order applies to state agencies, Duke University voluntarily adopted Ban the Box in 2018 for all positions. North Carolina law prohibits employers from inquiring about expunged records. Durham has also adopted local Ban the Box policies for city jobs. Private employers in North Carolina are not required by state law to delay criminal history inquiries but must still comply with federal EEOC guidelines.

Healthcare-Specific Considerations

The healthcare industry involves direct patient care, access to medications, and handling of sensitive information, creating specific regulatory requirements. The Office of Inspector General (OIG) maintains the List of Excluded Individuals/Entities (LEIE). Healthcare employers who hire excluded individuals face civil monetary penalties up to $20,000 per violation. Mandatory exclusions (minimum 5 years, often permanent) apply to: healthcare fraud convictions, patient abuse or neglect, felony health care fraud or theft, and felony controlled substance offenses. Duke must screen all hires against the LEIE and SAM databases. Clinical positions requiring licensure face additional state board requirements. Non-clinical support positions have fewer regulatory barriers.

Company Overview

Duke Health is a world-class academic health system comprising Duke University Hospital (1,048 beds), Duke Regional Hospital (388 beds), Duke Raleigh Hospital (204 beds), Duke Health Lake Norman Hospital (123 beds), and over 140 specialty and primary care clinics across North Carolina. Headquartered in Durham, North Carolina, Duke Health is the largest employer in Durham County and the second-largest private employer in North Carolina. The health system attracted nearly 67,000 inpatient stays and nearly 5 million outpatient visits in fiscal year 2023.

Duke Health is committed to advancing health through innovative research, exceptional clinical care, and education of future healthcare leaders. The organization has been consistently recognized as a top employer, named among Forbes' "America's Best Employers" and "Best Employers for Women" for multiple consecutive years. Duke employs approximately 48,249 people across Duke University and Duke University Health System combined, with 77% of the health system workforce being women.

Company Fast Facts

• Founded: 1930 (Duke Hospital opened)

• Headquarters: Durham, North Carolina

• Employees: 26,278 full-time (DUHS); 48,249 total (Duke University and DUHS)

• Industry Rank: #1 Hospital in North Carolina (U.S. News & World Report)

• Major Operations: 4 hospitals, 140+ clinics across North Carolina

• CEO: Craig Albanese (Duke University Health System)

• Business Model: Nonprofit academic health system

• Research: $1 billion in annual sponsored research expenditures

Hiring Policy Analysis

Duke Health voluntarily adopted Ban the Box policies in 2018, removing criminal history questions from job applications. The company conducts background checks only after a conditional offer of employment has been extended, giving applicants the opportunity to demonstrate their qualifications before their record is considered. Duke's hiring process typically involves: online application, phone screening, in-person interview, conditional offer, background check and drug screen, health screening, and onboarding. The organization conducts individualized assessments as required by EEOC guidelines, evaluating each applicant's circumstances including the severity and recency of offenses and their relationship to the position.

Position-Specific Barriers

Barrier levels are determined by regulatory requirements, patient contact, access to medications, handling of finances, and professional licensure requirements.

Available Positions and Pay

Pay data compiled from Glassdoor, Indeed, PayScale, and company job postings. Actual compensation varies by location, shift, experience, and certifications.

Career Path Examples

Duke Health emphasizes internal advancement and offers comprehensive development programs. The organization provides tuition assistance up to $5,250 per year and career enhancement bonuses for certifications. Many leadership positions are filled through internal promotion.

Environmental Services Track: EVS Technician ($14-$18/hr) → Lead EVS Technician ($17-$20/hr) → EVS Supervisor ($22-$28/hr) → EVS Manager ($50K-$65K/yr). Advancement based on performance, reliability, and completion of Duke leadership training programs.

Food Services Track: Food Service Worker ($14-$17/hr) → Cook ($16-$20/hr) → Lead Cook ($18-$23/hr) → Food Services Supervisor ($45K-$55K/yr). Food safety certifications enhance advancement opportunities.

Patient Services Track: Patient Transporter ($17-$22/hr) → Lead Transporter ($19-$24/hr) → Transport Supervisor ($50K-$60K/yr). CNA certification can open paths to nursing care assistant roles with tuition support for nursing programs.

Background Check Process

Understanding Duke Health's background check process helps you prepare mentally and practically for what to expect. The company conducts background checks after extending a conditional offer of employment, giving applicants the opportunity to interview based on qualifications before their record is reviewed.

• What They Check: Criminal history (felonies and misdemeanors) at county, state, and federal levels; OIG/LEIE exclusion database; SAM (System for Award Management) database; identity verification through SSN trace and address history; employment history verification; education verification for positions requiring specific credentials; professional license verification (when applicable); drug screening (mandatory for all DUHS positions).

  
  

• Lookback Period: Standard 7-year criminal lookback per Duke policy. OIG exclusions have no time limit and are permanent or long-term. Employment verification typically extends 5-7 years. Certain serious offenses (violence, sexual crimes) may be reviewed beyond standard lookback.

  
  

• Timeline: The hiring process averages 2-4 weeks from application to hire based on employee reports. Background checks through HireRight typically take 3-7 business days. Additional time may be needed for out-of-state records or credential verification.

  
  

• Process Flow: Online application → Phone screening → Interview(s) → Conditional offer extended → HireRight background check authorization → Background check conducted → OIG/SAM databases checked → Drug screen at Employee Occupational Health → Results reviewed using individualized assessment → Pre-adverse or adverse action notice if applicable → Health clearance → Final hiring decision → Onboarding.

  
  

Disqualifying Factors

High Risk for Disqualification: OIG exclusion (absolute bar); healthcare fraud, Medicare/Medicaid fraud; patient abuse or neglect convictions; felony controlled substance offenses; recent violent felonies (especially for patient-facing roles); sexual offenses; theft or embezzlement (especially for positions with financial access); falsification of application (automatic disqualification).

Lower Risk (Case-by-Case): Non-violent property crimes (older than 7 years); DUI/DWI (except for positions requiring driving); misdemeanors unrelated to job duties; drug possession (personal use, not distribution) with documented rehabilitation. All subject to individualized assessment considering rehabilitation evidence, time elapsed, and job relatedness.

Your Rights as Applicant

• FCRA Protections: You must receive written notice and provide consent before Duke conducts a background check through HireRight. If denied based on the report, you're entitled to a copy and the right to dispute inaccuracies.

  
  

• Pre-Adverse Action Notice: Before a final decision, you must receive notice with a copy of the background report and a summary of your rights. You have reasonable time to respond and dispute inaccuracies.

  
  

• EEOC Protection: You have the right to an individualized assessment. Blanket exclusions based solely on criminal record are prohibited. Duke must consider the Green Factors before denial.

  
  

• Ban the Box: Duke voluntarily adopted Ban the Box in 2018. Criminal history inquiry occurs only after conditional offer, not on application or during initial interviews.

  
  

• Expungement Rights: North Carolina law prohibits employers from asking about expunged records. Expunged convictions should not appear on background checks. Research eligibility through NC Courts or legal aid.

Application Strategy

1. Verify OIG Status First: Before applying, confirm you are NOT on the OIG Exclusion List (LEIE) at oig.hhs.gov/exclusions. Exclusion is an absolute bar to healthcare employment. Also check SAM.gov for federal exclusions.

   
   

2. Target Support Services Positions: Focus on Environmental Services, Food Services, Laundry, and Facilities positions which have the lowest barriers and highest volume hiring needs. Avoid clinical positions initially if your record is recent or includes relevant offenses.

   
   

3. Apply Through Official Channels: Submit your application through careers.dukehealth.org. Duke posts positions on Indeed, LinkedIn, and Glassdoor. Check the careers page regularly as support services positions are posted frequently.

   
   

4. Prepare for the Interview: Research Duke Health's mission and values. Be ready to discuss your reliability, attention to detail, and commitment to patient safety. Emphasize teamwork and your desire for long-term employment.

   
   

5. Be Completely Honest: Never lie about your criminal history. Dishonesty is an automatic disqualifier and can result in termination even after hire. Wait until asked (after conditional offer) to discuss your record.

   
   

6. Prepare Your Narrative: Have a brief, honest explanation ready: acknowledge the offense without making excuses, describe what you learned, and explain how you've changed. Focus on rehabilitation, personal growth, and stability. Keep it concise (30-60 seconds).

   
   

7. Document Rehabilitation: Gather evidence of positive changes: completion of treatment programs, educational certificates, vocational training, stable housing, employment history, community involvement, and references from employers or probation officers.

   
   

8. Check Expungement Eligibility: Research whether your offense qualifies for expungement under North Carolina law. Contact NC Second Chance Alliance or local legal aid for assistance. Expunged records cannot be reported on background checks.

Tips for Applicants with Records

1. Healthcare Has Constant Hiring Needs: Duke Health hired over 8,123 individuals in 2023-24 and has increased its workforce by 16% since 2019. Support services departments have consistent turnover. Don't be discouraged by individual rejections—keep applying.

   
   

2. Start Entry-Level, Advance Within: Many successful careers at Duke begin in EVS or Food Services. Prove reliability through consistent attendance and quality work. Duke's tuition assistance and career enhancement programs provide training for advancement.

   
   

3. Run Your Own Background Check First: Know what will appear before the employer sees it. Order your own criminal background check from a consumer reporting agency. Dispute any errors or outdated information in advance.

   
   

4. Understand Healthcare Requirements: Healthcare environments require infection control awareness, patient confidentiality (HIPAA), and attention to safety. Demonstrate understanding of these principles during interviews.

   
   

5. Pass the Drug Test: If you have substance issues, address them completely before applying. Duke requires mandatory urine drug screening for all health system positions. Positive results mean ineligibility to reapply for one year.

   
   

6. Highlight Stability and Reliability: Emphasize stable housing, reliable transportation, and any consistent work history. Healthcare employers especially value dependability and low absenteeism.

   
   

7. Network and Use Employee Referrals: Current Duke employees can provide referrals. Employee referrals often receive priority consideration. Network through LinkedIn or NCWorks Career Centers to connect with current employees.

   
   

8. Be Flexible on Scheduling: Willingness to work second shift (3pm-11:30pm) or third shift (11pm-7:30am), weekends, and holidays increases your chances significantly. These shifts often have premium pay differentials.

Benefits Overview

Duke Health offers a comprehensive benefits package consistently rated highly for coverage and affordability. Benefits begin on the first of the month following hire date for benefits-eligible employees (working 20+ hours per week).

• Compensation: Competitive hourly wages with shift differentials for evening, night, and weekend work. Annual merit increases based on performance. 73% of employees report receiving overtime pay.

  
  

• Retirement: Duke Faculty and Staff 403(b) Retirement Plan through Fidelity. Employees can contribute pre-tax or Roth after-tax up to $23,000/year (2024). Duke offers a pension plan vested after 5 years of service.

  
  

• Health Benefits: Choice of medical plans including Duke Select (HMO), Duke Basic, and Blue Care. Coverage for employees and dependents. Dental and vision plans available. Health Savings Account with Duke seed money contribution.

  
  

• Time Off: Paid time off (PTO) that accrues based on years of service. Six designated holiday days annually. Separate sick time that rolls over. Parental leave available.

  
  

• Additional Benefits: Tuition Assistance up to $5,250/year after 6 months; RN Tuition Assistance covering up to 90% for nursing programs; Employee Assistance Program with free counseling; earned wage access through DailyPay; employee discounts; free flu shots; career development programs.

  
  

• Employee Perspectives - Pros: Excellent health insurance within Duke network; strong pension plan after 5 years; generous tuition assistance; supportive work culture; opportunities for advancement; job stability at large healthcare system.

  
  

• Employee Perspectives - Cons: Parking costs; PTO policies seen as less generous than some competitors; healthcare costs outside Duke network; fast-paced environment can be stressful; wage increases described as modest by some.

Frequently Asked Questions

1. Does Duke Health hire people with felonies?

   Yes, Duke Health hires individuals with felony convictions for certain positions, particularly in support services like Environmental Services, Food Services, and Facilities. However, individuals on the OIG Exclusion List (LEIE) are permanently barred from any position. Duke conducts individualized assessments considering the nature of the offense, time elapsed, and job relatedness. Clinical and patient care positions face stricter scrutiny.

   
   

2. What is the background check process at Duke Health?

   Duke Health conducts background checks through HireRight after extending a conditional offer. The check includes criminal history (7-year lookback), OIG/LEIE exclusion database, SAM database, SSN trace, employment verification, and drug screening. You'll receive an email with instructions to complete the background check. The process typically takes 3-7 business days.

   
   

3. How far back does the background check go—what is the lookback period?

   Duke Health's standard criminal lookback period is 7 years. However, OIG exclusions are permanent and have no time limit. Employment verification typically extends 5-7 years. Certain serious offenses (violent crimes, sexual offenses) may be reviewed beyond the standard lookback period depending on the position sought.

   
   

4. What types of convictions make hiring more difficult at Duke Health?

   The most difficult convictions are those resulting in OIG exclusion: healthcare fraud, patient abuse, controlled substance felonies. Other challenging convictions include violent felonies (especially for patient-facing roles), theft and embezzlement (for positions with financial access), sexual offenses, and any recent felonies within the past 2-3 years. Non-violent property crimes older than 7 years typically face less scrutiny.

   
   

5. What are the best entry-level roles at Duke Health for applicants with a record?

   The best entry points are: Environmental Services/Housekeeper ($14-$18/hr), Food Service Worker ($14-$17/hr), Laundry Worker ($14-$16/hr), and Materials Handler ($15-$19/hr). These positions have minimal patient contact, no medication access, and no professional licensure requirements. Patient Transport ($17-$22/hr) is also accessible for those without violence or abuse convictions.

   
   

6. Does Duke Health drug test, and what kind of test do they use?

   Yes, Duke Health conducts mandatory pre-employment drug testing for all Duke University Health System positions. Testing is done through urine screening at Employee Occupational Health & Wellness. Staff are screened for illegal drugs and alcohol levels. A positive result rescends the conditional offer and makes you ineligible to reapply for one year. Refusing to test is treated the same as a positive result.

   
   

7. When during the hiring process will Duke Health ask about criminal history?

   Duke Health voluntarily adopted Ban the Box in 2018. Criminal history questions are not on the job application and are not asked during initial interviews. Background checks are conducted only after a conditional offer of employment has been extended, allowing you to be evaluated on your qualifications first.

   
   

8. Can someone advance to management at Duke Health if they have a felony?

   Yes, advancement to supervisory and management positions is possible for individuals with felony records, particularly in support services departments. Duke emphasizes internal promotion and offers tuition assistance and career development programs. Advancement depends on job performance, reliability, and time since conviction. Management positions may involve additional background review.

   
   

9. How long does the hiring and background check process take?

   The typical hiring timeline is 2-4 weeks from application to start date. Background checks through HireRight typically take 3-7 business days after you complete the authorization. Drug screening and health clearance add another 1-3 days. Factors that may extend the timeline include out-of-state records, credential verification, and volume of applicants.

   
   

10. What can applicants do to improve their chances of getting hired at Duke Health?

    Key strategies include:

    (1) Verify you're not on the OIG exclusion list before applying;

    (2) Target support services positions with lower barriers;

    (3) Prepare documentation of rehabilitation;

    (4) Check expungement eligibility for old convictions;

    (5) Be completely honest about your record;

    (6) Prepare a concise narrative about your offense and rehabilitation;

    (7) Demonstrate reliability, stability, and genuine interest in healthcare work;

    (8) Be flexible about shifts and locations;

    (9) Pass the drug test;

    (10) Follow up professionally after applying.

Alternative Second Chance Employers

If Duke Health doesn't work out, consider these employers known for fair chance hiring practices in healthcare and related industries in North Carolina:

Conclusion

Duke Health offers genuine opportunities for individuals with criminal records, particularly in support services positions like Environmental Services, Food Services, and Facilities. As one of North Carolina's largest employers with over 26,000 health system employees, the organization provides a realistic pathway to stable employment with competitive benefits and advancement opportunities. Duke's voluntary adoption of Ban the Box demonstrates commitment to fair chance hiring principles.

The work in support services is physically demanding and requires reliability, attention to detail, and commitment to patient safety. However, the compensation is competitive for the region ($14-$22/hr for entry-level positions), and the benefits package—including health insurance, retirement plans, and tuition assistance up to $5,250/year—is among the best available. Career advancement is actively supported through Duke's professional development programs and internal promotion culture.

Key Success Factors: Verify you're not on OIG exclusion list before applying; target support services positions; be completely honest about your record; prepare documentation of rehabilitation; pass the mandatory drug screen; demonstrate reliability and commitment to patient safety; be flexible on scheduling.

Biggest Barriers: OIG exclusion (permanent bar); healthcare fraud convictions; patient abuse convictions; controlled substance felonies; recent violent offenses; mandatory drug screening; extensive background checks.

For individuals committed to stable employment and willing to work in a demanding healthcare environment, Duke Health represents a significant opportunity. The combination of fair chance hiring policies, comprehensive benefits, and clear advancement pathways makes this one of the stronger options for second chance employment in North Carolina's healthcare sector.

Disclaimer

This guide provides general information and should not be considered legal advice. Hiring policies vary by position, location, and individual circumstances. While we strive for accuracy using publicly available sources including company websites, job postings, employee reviews (Glassdoor, Indeed), and salary databases (PayScale, ZipRecruiter), employment information and company policies may change without notice. Always verify current practices directly with Duke Health.

Inclusion in this guide does not guarantee employment. Background check laws, expungement procedures, and fair chance hiring requirements vary by state and should be confirmed with legal professionals. OIG exclusion status creates permanent employment bars in healthcare regardless of individual circumstances. Consult with an employment attorney or legal aid organization for specific legal advice about your situation.

Apply Now: https://careers.dukehealth.org