aGapeKAREz currently has agreements to provide contract nurses to medical facilities. These facilities require basic information about the nurses who perform services at their facilities. In an effort to provide better services to both the contract nurses and facilities, We have assembled the information required by various facilities in this enclosed application. If you wish to contract your services through aGapeKAREZ , please fill out the application. We will in turn forward this information to any facility you choose to work with. Please advise our staff of your available shift times and areas/departments of preference. Thank you for choosing aGapeKAREz. If you have any questions, please contact our office at 727-746-8533.

Drivers License, LPN/CNA license (RN verified online), Current certifications: BLS, ACLS, PALS, NALS, CPI, Current TB/PPD test or Chest X-ray, Current Vaccines: Hep B, MMR, Tetanus, Flu, Covid (or exemptions) (Titers)

In accordance with the privacy regulations promulgated under the Health Insurance Portability and Accountability Act, 45 (fort-five) CFR parts 160 and 164 (the "Privacy Regulations"), aGapeKAREz LLC and Nurse Employee/Contractor understand and agree to abide by the facility privacy policies and to not use or further disclose a patient's personal health information except as expressly permitted by the agreement or as otherwise authorized in writing by the patient through a consent or authorization meeting the requirements of the privacy regulations. aGapeKAREZ LLC and NURSE EMPLOYEE/CONTRACTOR may only use a patient's personal health information for the sole purpose of treatment, and/or health care operations and may not release any information to unauthorized parties. aGapeKAREz and NURSE EMPLOYEE/CONTRACTOR agree to implement appropriate safeguards to prevent the unauthorized use and disclosure of any patient's personal health information received by facility under this agreement. In addition aGapeKAREz LLC and NURSE EMPLOYEE/CONTRACTOR shall make available to the facility the protected health information for amendment purposes, should changes to the information be necessary or to provide an accounting of disclosure of the protected health information. If any unauthorized disclosure of personal health information occurs, aGapeKAREz LLC and NURSE EMPLOYEE/CONTRACTOR shall immediately contact facility to inform them of the disclosure and any remedial action taken to prevent further disclosures aGapeKAREz LLC and NURSE EMPLOYEE/CONTRACTOR understand that any unauthorized disclosure of a patient's personal health information is grounds for immediate termination of the agreement and/or staffing assignment.

You have the right to confidentiality - that means that the information given by you will not be released without your written consent, except to facilities in which you have or will work. We do not discriminate in the delivery of services. This means you will not be treated differently from others because of race, color, sex, age, disability, religion, nation origin, or political beliefs. This gives aGapeKAREz LLC permission to release any contracted facility the employee's/contractor credentials, including, but not limited to: background check, health screening, certifications and/or license, etc