Credentials / Documents
Upload all required documents for employment here. Images should be clear to read and pages should not be cut off. If an image is unclear or not completed properly, this may cause your application to be REJECTED. Thank you
Name
*
First Name
Middle Name
Last Name
Personal email address:
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
CPR card
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CPR required (ACLS RN only)
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ACLS
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CPR required (ACLS RN only)
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CPI
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Behavioral Health certifications
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Proof of car insurances
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Required for Home Health Shifts
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Misc Certifications
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CPR required (PALS, CPI, Etc)
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Education Verification
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LPN / RN - Picture of Diploma or School transcript
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TB skin test / TB Chest Xray
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must be less than 1 year old
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Background Check Authorization
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Download, Print, and Complete from website.
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2nd Injury Questionnaire
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(Louisiana only) Download, Print, and Complete from website.
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Vaccine Records
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MMR, Hep B, Tetanus/TDaP, FLU
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Flu Shot
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Declining may require mask to be worn at shift
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Hepatitis B vaccine (3 shots)
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Decline if unable to submit
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Tetanus / TDaP vaccine
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Respiratory Fit Test
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Annual Renewal needed
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Tax Form W4
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Federal Tax forms
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Tax Forms L4
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I-9 form
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Tax forms (2 forms of Identification required as well)
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Miscellaneous Docs
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See the I-9 form for requirements (DL and SSC)
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LHC - LTAC Forms
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LHC LTAC Signed forms
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Savoy Medical Center forms
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Submit the signed forms from SMC packet
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OGH form
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OGH security form - required to begin orientation
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Acadia General forms
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Acadia General forms - required to begin orientation
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