2370 York Road, E-1          

  Jamison, Pa 18929             

Phone: 267-261-6609           

1. Accessing Act 126 Courses

2. Physical and PPD

3. Criminal Record Check

4. FBI Finger printing

​5. ACT 168 form

6. Child Abuse Clearance

7. ACT 24 form

​8. W-9 form

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• Current PA Nursing License or Compact License​
  
• Current PA Drivers License
  
• PA Criminal Record Check
• Current CPR certification
  
• Independent Contractor Agreement and Profile
  
• Independent Contractor Waiver
  
• Malpractice/Liability Insurance
  
• ACT 168 form(s)
  
• ACT 24 Arrest and Conviction Report
  
• Physical and PPD or Chest X-ray for positive PPD ​
  
• FBI Finger printing for the Department of Education or Department of Public Welfare (use code: ​1KG6XN)
  
• Child Abuse Clearance
  
• ACT 126 Ethics Certification
• Narcan Certification
  
• W-9
  

Please click the following links for the forms listed below:

Required Documents and Credentials: