The following competencies must be completed annually in order for you to remain active with Prestige Healthcare Staffing. A Quality Control Expiration notice will be sent out to you 45 days before a competency is set to expire. Our OSHA, HIPAA and Skills Checklists are administered by Prophecy Health. If you did not receive an email with a link to complete these competencies, please call us and we will email them to you.
FORMS NEEDED BELOW:
-Influenza Education and Vaccination Status Form
-Physician form or Physician statement
-Conflict of Interest Statement
-A TB test from the past twelve months or a Chest X-ray within five years (if you test positive for TB).
-TB Questionnaire (only complete if you test positive for TB).
The following documents and licenses are required and must be on file for all employees. Please call us to schedule an appointment. We do not accept walk-in appointments.
Our application may be completed by selecting the “Apply Now” button below. All other forms may be downloaded by clicking on their links. Our OSHA, HIPAA and Skills Checklists are administered by Prophecy Health. We will send you a link to complete these tests after you complete your interview.
1. Application Documentation:
– Employment Verification Form (Please complete two (2) forms)
– Employment Eligibility Form (I-9 Form)
– Conflict of Interest Form
– State W-4 Form
– Federal W-4 Form
– Two Professional References (one is required to be a Charge RN or Manager who can evaluate your skills) Please give us both cell and work numbers.
– Criminal Background Check
– Influenza Education and Vaccination Status Form (annual flu vaccination is required to staff most of our clients).
2. Health Requirements
– A physical or physicians statement from the past twelve months (annual requirement)
– Hepatitis B Documentation (vaccination series, titer, or signed declination)
– A TB test from the past twelve months or a recent Chest X-Ray (TB test is an annual requirement)
– TB Questionnaire – Only complete this if you test positive for TB.
– Proof of Immunity to Rubeola and Rubella and Mumps (positive titer or two MMRs within ten years)
– Positive Varicella titer
– Urine drug screen
– Respirator fit test (this is an annual requirement and can be completed in our office)
– Proof of Flu Vaccination (annual flu vaccination is required in order to staff at most hospitals).
3. Licenses and Certifications
– A current Illinois Nursing License, CMA certification, or CNA Certification
– A current CPR/ACLS card (only American Heart Association Cards are accepted)
– Proof of eligibility to work in the United States (Social Security card and Driver’s License or Passport or Birth Certificate)
All of the above items must be in your file before you will be permitted to work.
Prestige Healthcare Staffing operates our business in accordance with all applicable laws, rules and regulations and the highest ethical standards of fairness, honesty and common sense. All employees are encouraged to report any perceived breach of ethics or conflict of interest. You may do so anonymously by clicking on the JCAHO Compliance Reporting link below.
All completed forms are sent via email to Kristi Hughes FNP-BC Director of Compliance. Your email is confidential and will not result in any retaliation against you.
To report any perceived infraction or impropriety made by Prestige Healthcare Staffing or one of our employees, please call JCAHO’s Office of Quality Monitoring at (800) 994-6610 or email: firstname.lastname@example.org