Allied Hands Medical Staffing Onboarding

Employment Onborading
Worker Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
SSN (Last 4 digits)*
Emergency Contact Name*
Emergency Contact Number*
Please enter a valid phone number.
Position Applying For*
Employment Type*

Full TimePart TimePer Diem
Availability*

MorningsEveningsNights
Do you have reliable Transportation?*

YesNo
Professional References
Reference 1 Name*
Reference 1 Phone*
Reference 2 Name*
Reference 2 Phone*

Required Document Uploads
Resume*

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Government ID*

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Back Of Government ID*

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Social Security Card*

Cancelof
CNA/LPN/RN/RT License*

Cancelof
CPR Card*

Cancelof
Physical Within 1 Year*

Cancelof
PPD or QuantiFERON Test*

Cancelof
Flu Shot (Seasonal)*

Cancelof
MMR Vaccination or Titer*

Cancelof
COVID Vaccination Card

Cancelof

Signed Forms
HIPAA Confidentiality Agreement

Purpose: To protect the privacy and security of Protected Health Information (PHI) of patients and employees.

Definition of PHI: PHI includes any information about health status, provision of healthcare, or payment for healthcare that can be linked to an individual.

Confidentiality Obligations: Employees must keep all PHI confidential and only access it when necessary for job duties.

Prohibited Actions: Unauthorized use or disclosure of PHI is strictly prohibited.

Reporting Violations: Any suspected violations must be reported immediately to the Compliance Officer via email at info@alliedhandsmedicalstaffing.com or phone at 914-500-8782.

Consequences of Violations: Violations may result in disciplinary action, up to and including termination of employment and legal penalties.

Acknowledgment: By signing below, you acknowledge that you have read, understand, and agree to comply with this HIPAA Confidentiality Agreement.
Worker Name*

First NameLast Name
Signature*

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Date Signed*

MonthDayYear
Date
GENERAL CONFIDENTIALITY & NON-DISCLOSURE AGREEMENT (NDA)

Purpose: To protect confidential information and maintain privacy.

Definition of Confidential Information: Includes all non-public information disclosed during employment, including business, technical, and personal data.

Worker Obligations: Employees must keep all confidential information secure and not disclose it without authorization.

Prohibited Actions: Unauthorized use, disclosure, or copying of confidential information is strictly prohibited.

Ownership of Work and Documents: All work products and documents created during employment are the property of the company.

Duty to Report: Any suspected breaches must be reported immediately to the Compliance Officer via email at info@alliedhandsmedicalstaffing.com or phone at 914-500-8782.

Consequences of Breach: Breaches may result in disciplinary action, termination, and legal penalties.

Term of Agreement: This agreement remains in effect during and after employment.

Acknowledgment: By signing below, you acknowledge that you have read, understood, and agree to comply with this agreement.
Worker Name*

First NameLast Name
Signature*

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Date Signed*

MonthDayYear
Date
Abuse, Neglect, & Misconduct Policy Acknowledgment

By signing below, you acknowledge that you have read, understand, and agree to comply with the Abuse, Neglect, & Misconduct Policy. You agree to report any suspected abuse, neglect, or misconduct immediately to the appropriate authorities and understand the consequences of failing to do so.
Worker Name*

First NameLast Name
Signature*

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Date Signed*

MonthDayYear
Date
JOB DESCRIPTION ACKNOWLEDGMENT

Universal Duties and Responsibilities: Employees are expected to perform all assigned duties diligently and responsibly.

Professional Expectations: Employees must adhere to professional standards and ethics at all times.

Care Plan and Clinical Compliance: Employees must follow care plans and comply with clinical guidelines.

Attendance, Timekeeping, and Conduct: Employees are required to maintain punctuality, accurate time records, and appropriate workplace behavior.

Compliance Statement: Employees agree to comply with all company policies and applicable laws.

Acknowledgment: By signing below, you acknowledge that you have read, understood, and agree to the terms outlined in this job description acknowledgment.
Worker Name*

First NameLast Name
Signature*

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Date Signed*

MonthDayYear
Date

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Employment Onborading

Worker Information

Professional References

Required Document Uploads

Signed Forms