Last Name: First Name:

Completed Application (must be signed and date by all parties)
Professional License
Employment Eligibity Verification I-9 (Proof of Residency)

      Confirm:
             Physical Exam
             TB Test Form
             Hepatitis-B Declination Form
             Introduction to other department and employees
             W-4 Form
             Length of probationary period, if applicable
             Fire and Safety
             Reference Check
             Call in Sick procedure
             Work hours/scheadule (i.e., 7.5 hours per day, Monday through Friday, etc.)
             Current CPR Card
             Employee Safety Security
             Orientation Checklist
             Management of Hazardous Waste
             Initial Competency
             Signed Job Description
             Nursing Bag Technique (for nurses only)
             Emergency Management
             Confidentiality of Patients Information
             Motor Vehicle Record check (if applicable)
             Health Benefits (date benefits will start)
                  
             Sick leave benefits (date benefits will start)
                  

Criminal Background Check (if applicable)
Provide employee the office phone number that has been designated for him/her or provide the office phone number that employee should give family in order to contact the employee in event of emergency during first week of work

Comments:

Allied Home Health Care is Medicare, Humana, and PublicAid Certified