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Today's Date (DD/MM/YYYY)  /   / 

Dear: Applicant's Name ,

Thank you for your interest in PRN, Inc. Below is a list of the required documents you will need to return to our office along with your completed paperwork.

• Current Maryland nursing license or C.N.A. / G.N.A.
• Current C.P.R. / A.C.L.S. / P.A.L.S.
• Drivers license
• Social security card
• Hepatitis B
• Titers, MMR, Chicken Pox
• PPD or Chest X-Ray
• Certification of any specialized training
• Passport / drivers license size photo for I.D. Badge
• Criminal Background
• Check Pre-employment drug screen with negative result
• 2 professional references
• Signed W-4
• Signed Direct Deposit form if requested
• HIPPA Compliance form
• JCAHO / OSHA Compliance form including age specific competencies
• Current Skills Check List
• Current Clinical Evaluation
• Signed employment terms agreement

Please contact me should you have any questions regarding this application. I look forward to working with you in the near future.

Sincerely,
Sharon Davis
Operations Manager
sdavis@prnhealthcare.com

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