Charisma SPD – Multi-Role Intake Application (Training, Internship & Staffing)

1
Which program or role are you applying for?* This field is required.
Central Sterile Processing (CSP) Training Enrollment
CSP Internship Placement Request
Temporary Staffing Application – Central Sterile Processing
Temporary Staffing Application – Nursing (RN/LPN/CNA)
Security Guard Training Course Enrollment
Nursing Assistant (CNA) Training Enrollment
Housekeeping / Environmental Services (EVS) Staffing Application
2
Full Legal Name* This field is required.
First Name
Last Name
3
Preferred Name (if different)
4
Email Address* This field is required.
example@example.com
5
Mobile Phone Number* This field is required.
Please enter a valid phone number.
6
Home Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Date of Birth* This field is required.
Date
Month
Day
Year
8
Emergency Contact Name* This field is required.
9
Emergency Contact Phone* This field is required.
Please enter a valid phone number.
10
Preferred Contact Method* This field is required.
Email
Phone
Text/SMS
11
Are you authorized to work in the United States?* This field is required.
Yes
No
12
Upload proof of work authorization (if applicable)* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
13
Upload photo ID (front)* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
14
Upload photo ID (back)* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
15
Last 4 digits of SSN (for staffing roles only)
16
Course Type* This field is required.
8-hr
16-hr
Renewal
Other
17
Schedule Preference* This field is required.
Weekday
Weekend
Evenings
18
Preferred Time Slot (3-hour intervals)* This field is required.
7:00 AM – 9:00 AM
9:00 AM – 12:00 PM
12:00 PM – 3:00 PM
3:00 PM – 6:00 PM
19
Security Guard Training Course Enrollment* This field is required.
I have read and agree to the cancellation/refund policy
20
Availability Window* This field is required.
ASAP
2–4 weeks
1–2 months
3+ months
21
Preferred Borough/Facility Type
Lincohn Hospital
NYU Brooklyn Medical Center
Westchester Medical Center
Harlem Hospital
22
Certified?* This field is required.
Yes
No
23
Travel Radius* This field is required.
<10 mi
10–25
25–50
50+
24
Work History Format* This field is required.
Upload resume only
Provide brief checklist
25
License Type* This field is required.
RN
LPN
CNA
26
State* This field is required.
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
27
License Number* This field is required.
28
License Expiration* This field is required.
Date
Month
Day
Year
29
Compact?
Yes
No
30
Specialty Areas
Med-Surg
ICU
ER
OR
LTC
Home Care
Pediatrics
Psych
Other
31
Years of Nursing Experience* This field is required.
<1
1–2
3–5
6–10
10+
32
Certifications
BLS (required)
ACLS
PALS
CNA Cert
Other
33
Shift Availability
Morning
Afternoon
Evening
Night
34
Travel Radius* This field is required.
<10
10–25
25–50
50+
35
Hospital/Clinical Cleaning Experience?* This field is required.
Yes
No
36
Years of Experience
<1
1–2
3–5
6–10
10+
37
Facility Types
Hospital
Clinic
LTC
Other
38
Experience Areas
Terminal cleaning
OR cleaning
Isolation rooms
Floor care
Waste handling
Linen
Other
39
Availability/Shift Preference
Morning
Afternoon
Evening
Night
40
Physical Requirements Acknowledgment* This field is required.
I acknowledge
41
Upload your resume (required for staffing roles)* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
42
Upload your nursing license (required for Nurse staffing role)* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
43
Upload other supporting documents (optional)
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
44
Immunization/Vaccination Proof (Optional)
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
May be required by facility.
Cancelof
45
Headshot/Photo (Optional)
46
I have read and understand the Charisma SPD Certification & Staffing Policy & Procedure.* This field is required.
I acknowledge
47
Terms & Privacy acknowledgment* This field is required.
I acknowledge and agree to the Terms of Service and Privacy Policy
48
Optional Text-Message Consent
I consent to receive text messages from Charisma SPD about application and enrollment updates, staffing or assignment updates, class or clinical scheduling, payment or document reminders, customer support, and other service-related updates. Message frequency varies. Message and data rates may apply. Reply STOP to opt out and HELP for help. SMS consent is not required to submit an application or purchase services.
49
Attestation of truthfulness* This field is required.
I certify the information provided is true and complete
50
Policy compliance acknowledgment* This field is required.
I understand I may be removed from the program/placement or disqualified from assignment for policy violations or falsified information
51
Cancellation/Refund Policy acknowledgment* This field is required.
I have read and agree to the Cancellation/Refund Policy
52
Signature (please sign below)* This field is required.
53
Please review your application before submitting. Once submitted, you will receive a confirmation and next steps by email.
54
Eligibility Acknowledgments* This field is required.
I am 18 or older
I can provide government ID
I will complete course requirements
55
Session Type* This field is required.
Weekend
Weekday
56
Preferred Start Month* This field is required.
Next available
Within 30 days
1–2 months
3+ months
57
Highest Education Level* This field is required.
Less than HS
HS-GED
Some College
Associate
Bachelor
Graduate
58
Primary Goal
New career
Up-skill
Certification prep
Job placement
Other
59
Schedule Preference* This field is required.
Weekday
Weekend
Evenings
60
Highest Education Level* This field is required.
Less than HS
HS-GED
Some College
Associate
Bachelor
Graduate
61
Primary Goal
New career
Job placement
Certification
Other
62
Specify other course type* This field is required.
63
CHARISMA SPD CERTIFICATION & STAFFING POLICY & PROCEDURE
1. PURPOSE 
This Policy establishes standardized, error-preventive requirements for collecting, validating, safeguarding, and processing applicant information submitted through the “Central Sterile Processing (CSP) Temporary Staff Application – Charisma SPD” (the “Application Form”). The objective is to ensure consistent intake, improve data integrity, reduce processing errors, support credentialing readiness, and facilitate compliant placement of temporary CSP personnel. 

2. SCOPE 
This Policy applies to: 
(a) all individuals submitting applications for CSP temporary/per diem/contract assignments through Charisma SPD Certification & Staffing (“Charisma SPD”); 
(b) all Charisma SPD personnel and contractors who create, administer, review, store, transmit, or otherwise process applicant information (including Recruiting, Credentialing, Compliance, HR/Operations, and Form Administrators); and 
(c) all electronic forms, workflows, and document uploads used to collect applicant identity, contact information, addresses, work authorization information, licensure/certifications, background disclosures, and supporting documents. 

3. DEFINITIONS 
3.1 “Applicant” means any individual submitting information for consideration as CSP temporary staff. 
3.2 “Credentialing” means the verification of an Applicant’s eligibility and qualifications, including identity and work authorization (as applicable), licenses/certifications, disclosures, training, competency documentation, and supporting records required by Charisma SPD, clients, or applicable laws/regulations. 
3.3 “Validation Controls” means field types, input constraints, masks, ranges, required settings, and error messages that reduce invalid or incomplete entries. 
3.4 “Conditional Logic” means configuration rules that show or require follow-up fields only when applicable (e.g., a “Yes” response displays an explanation field; a “No” response hides the explanation field and it is not required). 

4. POLICY STATEMENTS (MANDATORY CONTROLS) 

4.1 DATA ACCURACY, FORM STANDARDIZATION, AND ERROR PREVENTION 
Charisma SPD shall configure and maintain the Application Form with the following mandatory controls: 

4.1.1 Correct Field Types 
The Application Form must use appropriate field types to reduce entry errors: 
(a) Email addresses: Email field type; 
(b) Phone numbers: Phone field type (United States format); 
(c) Addresses: Address field type with structured sub-fields (street, city, state, ZIP); 
(d) Dates: Date Picker field type; 
(e) Numeric values (e.g., years of experience, rates, hours, totals): Number (or Currency) field type. 

4.1.2 Required Fields (Minimum Necessary) 
Fields shall be designated “Required” only where necessary to: 
(a) establish Applicant identity and contactability; 
(b) determine baseline eligibility; 
(c) support credentialing intake and verification; and 
(d) satisfy client, contractual, or compliance requirements. 

4.1.3 Validation Rules, Masks, and Error Messages 
Validation Controls must be implemented to prevent invalid entries and guide Applicants with clear error messages. Where feasible, error messages shall be displayed at the field level. 

4.1.4 Conditional Logic and Non-Applicability Controls 
If a response is “No” (or otherwise indicates non-applicability), any related follow-up fields must be: 
(a) hidden; and 
(b) not required. 
No follow-up field shall remain required while hidden. 

4.1.5 Submission Blocking 
The Application Form must not permit submission unless all required fields and validations pass. The form shall be configured to disable submission until validation is satisfied. 

4.2 APPLICANT ELIGIBILITY CONTROLS 

4.2.1 Minimum Age Requirement (18+) 
(a) Date of Birth must be required. 
(b) The Application Form must enforce that an Applicant is at least eighteen (18) years old at the time of submission by restricting date selection (maximum selectable date = today minus 18 years). 
(c) The error message shown for this validation must read exactly: “Applicant must be 18 years or older.” 

4.2.2 Work Authorization Requirement 
(a) The Application Form must require an Applicant to confirm whether they are authorized to work in the United States. 
(b) If an Applicant selects “No,” the Application Form must display a notice reading exactly: “You must have authorization to work in the U.S. to proceed.” and must prevent completion/submission for placement processing (e.g., conditional end of form). 

4.3 IDENTITY AND SENSITIVE INFORMATION HANDLING 

4.3.1 Data Minimization (Sensitive Information) 
Charisma SPD shall collect only the minimum information necessary for legitimate business purposes. Sensitive information (including identity and payroll-related information) shall be collected only where necessary for credentialing, onboarding, payroll processing, or legal compliance. 

4.3.2 Social Security Number (SSN) Collection 
(a) If SSN is collected at the application stage, Charisma SPD shall consider making it optional unless a documented business need requires collection at intake. 
(b) If collected, SSN must be configured to reduce errors by using either: 
(i) a split-field format (3 digits / 2 digits / 4 digits), displayed as ###-##-#### with visible separators; or 
(ii) a strict input mask equivalent to 999-99-9999. 
(c) Where split-field format is used, each part must enforce exact digit length and numbers-only entry. 
(d) Helper text must state: “Numbers only. Do not include spaces. We protect this information.” 

4.3.3 Driver’s License Information 
(a) Driver’s license information shall be requested only when relevant to the position or assignment requirements. 
(b) If the Applicant indicates a driver’s license is issued/available, the form may display a driver’s license number field. 
(c) Driver’s license number must be validated for acceptable format (alphanumeric; hyphen permitted; minimum length 5). 

4.3.4 Access Controls and Confidentiality 
(a) Access to Applicant information, including uploads and sensitive data, shall be limited to authorized personnel with a job-related need. 
(b) Applicant data must be stored and transmitted using systems and settings that are access-controlled and designed to protect confidentiality. 

4.4 CREDENTIALING INTAKE REQUIREMENTS (PLACEMENT READINESS) 
The Application Form must collect (or initiate collection of) the following categories of information to support credentialing readiness: 
(a) Applicant identity and contact information; 
(b) Home address and conditional mailing address (when preferred contact method is mail); 
(c) Work authorization status and type (with conditional visa detail if applicable); 
(d) License/certification details including type, number, state, and expiration date; 
(e) Disclosure of restrictions/discipline on any license/certification and required explanation when “Yes”; 
(f) Background disclosure (felony question) and required explanation when “Yes”; 
(g) CSP experience indicators and competency inputs as required by Charisma SPD or client expectations; 
(h) Optional or conditional document uploads as configured (e.g., resume, ID, certifications). 

5. FORM CONFIGURATION STANDARDS (REQUIRED) 

5.1 MINIMUM VALIDATION RULES 
The Application Form must implement, at minimum, the following validations: 

5.1.1 Name 
Full Legal Name must allow letters, spaces, hyphens, and apostrophes only (no numbers). 

5.1.2 Preferred Name 
Preferred Name (if provided) must not include digits. 

5.1.3 Date of Birth 
DOB must enforce the 18+ rule described in Section 4.2.1 with the exact error message. 

5.1.4 Email 
Email must validate as a properly formatted email address. Error message must read exactly: 
“Enter a valid email address (example@domain.com).” 

5.1.5 Phone 
Phone must validate as a 10-digit United States phone number. Error message must read exactly: 
“Enter a valid 10-digit phone number.” 

5.1.6 ZIP Code 
ZIP must be validated as either 5 digits or 5+4. Error messages used should include: 
“Street address is required.” 
“Enter a valid ZIP code.” 

5.1.7 License Expiration Date 
License expiration date must not be in the past. Error message must read exactly: 
“Expiration date must be today or later.” 

5.1.8 Numeric Fields 
Numeric fields (years, rates, hours, totals) must use Number/Currency fields with reasonable constraints (e.g., years of experience minimum 0, maximum 60). 

5.1.9 Conditional Disclosures 
Any “Yes/No” disclosure that triggers an explanation must require the explanation only when “Yes” is selected; the explanation must be hidden and not required when “No” is selected. 

5.2 UPLOAD CONTROLS 
(a) Upload fields must restrict file types to: PDF, JPG, PNG. 
(b) Upload fields must be required only when necessary. 
(c) If uploads are behind a “Do you want to upload documents now?” question, upload fields must be hidden and not required when the Applicant selects “No.” 

5.3 REVIEW PAGE AND NOTIFICATIONS 
(a) The Application Form must enable a review page prior to final submission. 
(b) The Application Form must send a confirmation email to the Applicant upon successful submission. 
(c) The Application Form must send an administrative notification email to designated Charisma SPD personnel upon receipt of a submission. 

6. PROCEDURE 

6.1 INTAKE AND INITIAL REVIEW 
(a) Recruiting/Credentialing shall review submissions for completeness, eligibility, and obvious inconsistencies. 
(b) If required information is missing or invalid, the Applicant shall be contacted using the Applicant’s preferred contact method, and the missing information shall be requested. 

6.2 CREDENTIALING VERIFICATION 
(a) Credentialing/Compliance shall verify licenses/certifications for validity, state of issuance, and expiration dates. 
(b) Any reported restrictions/discipline shall be reviewed, and supporting documentation may be requested. 
(c) Work authorization documentation shall be reviewed where required for onboarding or client compliance. 
(d) Competency and experience claims may be validated consistent with client requirements and Charisma SPD standards. 

6.3 PLACEMENT READINESS 
Applicants may be advanced toward placement only after minimum eligibility requirements are met and required credentialing items are verified and documented in accordance with Charisma SPD processes. 

7. ROLES AND RESPONSIBILITIES 

7.1 Recruiting 
Responsible for Applicant communication, completeness checks, and coordinating next steps. 

7.2 Credentialing/Compliance 
Responsible for maintaining validation standards, verifying credentials, enforcing conditional logic requirements, and ensuring compliance with internal standards and client requirements. 

7.3 Operations/HR (as applicable) 
Responsible for onboarding coordination, secure handling of Applicant data, and ensuring retention/access practices are followed. 

7.4 Form Administrator 
Responsible for form configuration, maintenance of validation controls, conditional logic, and required settings consistent with this Policy. 

8. DATA RETENTION AND ACCESS 
(a) Applicant data shall be retained in accordance with Charisma SPD’s retention schedule and applicable contractual and legal requirements. 
(b) Access shall be role-based and limited to authorized personnel. 
(c) Sensitive information shall be handled as confidential and shared only as necessary for legitimate business purposes. 

9. EXCEPTIONS 
Any exception to this Policy (including disabling validations, altering conditional logic, or expanding collection of sensitive information) must be approved in writing by Compliance/Leadership and documented with the rationale, scope, and duration of the exception. 

10. ENFORCEMENT 
Failure to comply with this Policy may result in corrective action, up to and including revocation of system access and disciplinary measures consistent with Charisma SPD practices, as applicable. 

11. DISCLAIMER 
This Policy is an internal operational document and does not constitute legal advice. Charisma SPD reserves the right to modify this Policy and related form configurations at any time to meet operational, client, or compliance requirements. 

12. REVISION HISTORY 
Version 1.0 – Initial Release – Date: 01/01/2025 



64
Consent to background check (required for staffing roles)* This field is required.
I consent to a background check
Should be Empty: