Quality Healthcare Employment Form

Quality Healthcare Employment Form

QHC Employment Form Preview
  • Required Documentation

  • We appreciate your interest in our agency and look forward to you working with us. You are responsible for insuring that the following information is collected and on file in our Ridgeland, MS office. We ask that you have these credentials current and available at the time of the interview and keep them current and on file at all times. THERE WILL BE NO EXCEPTIONS. The information listed below must be updated annually, if applicable, and remain on file for a period of three years in 'active' or 'inactive' files. Please have this information available at time of interview. You will NOT be considered an active employee if any of these documentations are missing. Thank you in advance for your cooperation.

     Completed Application

     Verification and copy of current nursing License, Roster Number, or Certification

     Fingerprint Clearance Letter (Mississippi Only)

     Copy of Driver’s License and Social Security Card or Birth Certificate

     Current CPR Certification

     Documentation of Health Screen

    • Annual TB Skin Test of Chest X-Ray
    • Annual Physician Statement of Health
    • Shot Record
    • Drug Screen