Refer A Nurse And Earn $500!

Application Packet
Form I-9 (2010)
Form W-4 (2010)

Note: Skills test modules will be sent to you separately when packet has been received.

Please PRINT packet.
At this time, packets cannot be submitted online.

Handwritten Option:
Print the application, type or handwrite all of the information, then submit all requested documentation & certifications via fax or mail;
(or)
Electronic Option:
(detailed instructions are listed below)

Using the document autofill option, complete entire application electronically, PRINT; then sign; date & submit with copies of all certifications, etc. via fax or mail. This version gives you the opportunity to digitally sign all but page 4, which requires an actual signature.
Remember: at this time, packets cannot be submitted online.

Instructions:
1. If you use the .pdf forms autofill feature and you complete all fields on page# 4 (application page), information that you type will be copied to all applicable fields throughout the remainder of the packet. You will need to scroll through each page, completing remaining fields, clicking on boxes or radio buttons, etc.

2. Print the document, add your signature as needed and review to make sure all pages are complete.

3. Click on "File-Save As" and save the document to your computer.
(You cannot save the document to this website or submit online due to required signatures.)

4. Mail the pertinent documents (so that we will have original signatures on file.)

Employee Forms

Performance Eval-Prof Reference
Emergency Contact Information
Job Description-Nurses

Physician's Statement (annual physical)
ChickenPox Exposure Questionnaire
TB Screening Questionnaire

Change of Address

General Forms

Tax Home Status and Housing Representation Forms

Anthem Blue Cross Insurance Application

What to do if injured on the job
Workers Comp Guide for Employees
Workers Comp Claim Form