WVUHS Non-Employee Onboarding

1
Are you an intern/extern, independent contractor, volunteer or school faculty?* This field is required.
Unpaid Intern/Extern (student)
Independent Contractor
School Faculty
Volunteer
2
Independent Contractor - Full Legal Name:* This field is required.
First Name
Middle Name
Last Name
3
Independent Contractor - Contact Phone Number:* This field is required.
Area Code
Phone Number
4
Independent Contractor - Email Address:* This field is required.
john.doe@abccompany.com
5
Intern/Extern - Full Legal Name:* This field is required.
First Name
Middle Name
Last Name
6
Intern/Extern - Contact Phone Number: * This field is required.
Area Code
Phone Number
7
Intern/Extern - Email Address:* This field is required.
john.doe@school.edu
8
School Faculty - Full Legal Name:* This field is required.
First Name
Middle Name
Last Name
9
School Faculty - Contact Phone Number:* This field is required.
Area Code
Phone Number
10
School Faculty - Email Address:* This field is required.
john.doe@school.edu
11
Volunteer - Full Legal Name:* This field is required.
First Name
Middle Name
Last Name
12
Volunteer - Contact Phone Number:* This field is required.
Area Code
Phone Number
13
Volunteer - Email Address:* This field is required.
john.doe@mail.com
14
Select the facility where you will be located* This field is required.
Allied Health Solutions
Barnesville Hospital
Berkeley Medical Center
Braxton County Memorial Hospital
Camden Clark Medical Center
Harrison Community Hospital
J.W. Ruby Memorial Hospital / Children's Hospital (WVUH)
Jackson General Hospital
Jefferson Medical Center
Potomac Valley Hospital
Reynolds Memorial Hospital
St. Joesph's Hospital of Buckhannon
Summersville Regional Medical Center
Uniontown Hospital
United Hospital Center
United Summit Center
Wetzel County Hospital
Wheeling Hospital
WVU Innovation Center
WVUHS
15
Interns/Externs & School Faculty - Select the name of your school* This field is required.
Alderson Broaddus University (ABU)
Allegany College of Maryland
B.M. School of Practical Nursing
Belmont College
Ben Franklin Technical College
Blue Ridge Community and Technical College
Carver Career Center
Collins Career Technical Center
Eastern Gateway Community College (EGCC)
Eastern WV Community & Technical College (Eastern)
Fairmont State University (FSU)
Frederick Community College
Frostburg State University
Garrett College (GC)
Great Lakes Institute of Technology
Hagerstown Community College
Hocking College
James Rumsey Technical Institute
Kent State University
Laurel College of Technology (LCOT)
Lord Fairfax Community College
Marshall University (MU)
Mid Ohio Valley Technical Institute (MOVTI)
Mineral County Technical Center (Mineral Co Tech)
Monongalia County Technical Education Center (MTEC)
Mountwest Community Technical College (MCTC)
Ohio Northern University (ONU)
Ohio State University (OSU)
Ohio University Eastern OUE)
Pierpont Community & Technical College (Pierpont)
Preston High School (PHS)
Roane-Jackson Technical Center
Ross College (Ross)
Shenandoah University
Shepherd University
University of Charleston (UC)
University of Findlay
Valley College
Washington County Career Center
Washington State Community College
Waynesburg University (WU)
West Liberty University (WLU)
West Virginia Junior College-Bridgeport (WVJC-B)
West Virginia Junior College-Morgantown (WVJC-M)
West Virginia Northern Community College (WVNCC)
West Virginia University (WVU)
West Virginia University Parkersburg
Wheeling University (Wheeling U)
Wood County Technical Center
WVU School of Medicine
Other
16
Interns/Externs & School Faculty - If other, enter the name of your school.* This field is required.
e.g. West Virginia University, ABC company
17
Interns/Externs & School Faculty - Identify your educational program* This field is required.
Business Management & Finance
Health Information Technology
Human Resources
Information Technology
Nursing
Occupational Therapy
Physical Therapy
Radiology
Respiratory
Speech Therapy
Other
18
Interns/Externs & School Faculty - If other, enter the name of your educational program* This field is required.
e.g. West Virginia University, ABC company
19
Interns/Externs: Enter the name of your school contact* This field is required.
First Name
Last Name
20
Intern/Extern: Enter the phone number of your school contact* This field is required..
Area Code
Phone Number
21
Intern/Extern: Enter your school contact's email address* This field is required.
john.doe@abccompany.com
22
School Faculty: Enter the name of your supervisor* This field is required.
First Name
Last Name
23
School Faculty: Enter the phone number of your supervisor* This field is required..
Area Code
Phone Number
24
School Faculty: Enter your supervisor's email address* This field is required.
john.doe@abccompany.com
25
Upload a copy of your BLS card, if applicable
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
26
Enter the expiration date of your BLS card, if applicable
Date
Month
Day
Year
27
WVUHS Unpaid Intern/Extern, School Faculty & Independent Contractor Onboarding
28
I have reviewed the “WVUHS Unpaid Intern/Extern, School Faculty & Independent Contractor Onboarding Introduction” and will abide by all policies and procedures contained therein.* This field is required.Signature
29
WVUHS Basic Compliance TrainingNote: Training module is a PDF. Hyperlinks are not active. For copies of information within hyperlinks, please see your location’s manager/representative.
30
I have reviewed the “WVUHS Basic Compliance Training” and will abide by all policies and procedures contained therein.* This field is required.Signature
31
WVUHS Code of Ethical Conduct
32
I have reviewed the “WVUHS Code of Ethical Conduct” and will abide by all policies and procedures contained therein.* This field is required.Signature
33
WVUHS Confidentiality and Security AgreementNote: Training module is a PDF. Hyperlinks are not active. For copies of information within hyperlinks, please see your location’s manager/representative.
34
I have reviewed the “WVUHS Confidentiality and Security Agreement” and will abide by all policies and procedures contained therein.* This field is required.Signature
35
WVUHS HIPPA - Privacy and Security TrainingNote: Training module is a PDF. Hyperlinks are not active. For copies of information within hyperlinks, please see your location’s manager/representative.
36
I have reviewed the “WVUHS HIPPA - Privacy and Security Training” and will abide by all policies and procedures contained therein.* This field is required.Signature
37
WVUHS Dress and Appearance Policy
38
I have reviewed the “WVUHS Dress and Appearance Policy” and will abide by all policies and procedures contained therein.* This field is required.Signature
39
I hereby attest that the information provided in this onboarding form is true and correct to the best of my knowledge and I will abide by all policies and procedures provided.* This field is required.Signature
Should be Empty:

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.