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Application Forms

Below is a complete list of our application forms available to our clients to print and use as a guide when completing the application packet. Please give us a call at 484-380-2080 or toll free at 877-456-3579 with any questions.

Employee Checklist

Print and use as a guide when completing your packet)
1. Please include the following information in your packet:

  • Photograph: Original, recent Polaroid or passport photo. If you are coming in for an interview, we can take a photograph for you.
  • Diploma/Degree: Copies of diploma and/or degree(s). If you do not have, or cannot get copies of, your diploma/degree(s), please complete the “Educational Statement” .
  • Professional License(s): Copies of ALL current professional licenses and any license you have held in the past 5 to 10 years.
  • CPR Certification: Must be American Heart Association Course C or American Red Cross Certification for the Healthcare Professional.
  • ACLS Certification: Required for ER,ICU, Tele and PACU nurses. If you do not have current ACLS certification, it must be obtained prior to your start date. We will need a note stating the date, time and location of your course.
  • PALS Certification: Required for Maternal Child and Labor and Delivery departments. Preferred in ER.
  • NRP Certification:Required for Maternal Child and Labor and Delivery departments. Preferred in ER.
  • Proof of US Citizenship: Acceptable forms of ID include copy of unexpired US passport, birth certificate, or Alien Registration card, state driver’s license and SSN card.
  • Professional Certifications: i.e. CEN, CCRN, TNCC

2. Applicants must complete all the following forms, which have been provided for you on this web site. Please click on the titles below:

  • I-9: Required for proof of US Citizenship. It is required for all applicants.
  • Physical: Evidence of physical within thirty days of hire which includes PPD, Varicella, MMR for persons born 1957 or later, and hepatitis-B vaccination. If you have not had Hepatitis-B vaccination and do not wish to get it, please complete a Hepatitis-B Vaccination Waiver.
  • Application Form: Complete and submit this form on line.
  • Signature Forms: These forms must be completed by all applicants. Please print, sign and fax a copy, and mail the original.
  • Work References: List three professional references; two of which should be former (or current) supervisors. Please provide current phone numbers.
  • Voluntary Self Identification: Voluntary form helps the Federal Government track their veterans in the workplace to prevent discrimination.

Once you have completed your application, you may choose one of the following methods of delivery:

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