Pre-Employment Forms
To get started, please complete an Application, Employment Agreement and Skills Assessment for your modality or specialty. If you prefer, you may submit your resume along with a completed page 1 and a signed page 2 of the Application.
Forms on this page are downloadable PDF and Office files.
You will need Acrobat Reader version 5.0 or later to open PDFs. The latest Acrobat Reader version is available at http://www.adobe.com.
You will need an Office file viewer such as Microsoft Office or OpenOffice to open them. The latest OpenOffice suite is available at http://www.openoffice.org/.
Some forms, marked with an asterisk (*), may be completed on your computer then printed, or you can print them first and complete them by hand. When ready, fax them toll-free to 877-998-9940.
• Application and Work History*
• Temporary Employee Agreement*
• Background Check Release*
• Release Authorization for Reference Checks *
Skills Assessment Forms (for your specialty or modality)
Imaging Skills Forms:
• MRI*
• Radiation Therapy*
• Ultrasound, Echo, Nuc Med*
• XRay, CT*
Therapist Skills Forms:
• Physical Therapy*
• Respiratory Therapy*
Post-Hire Forms --
Documents Check Lists: We have posted downloadable listings of the forms and documents employees must submit before starting their first assignment.
Imaging and medical professionals CLICK HERE for Forms Check List.
Downloadable forms available on this site are:
• ADP Direct Deposit Authorization*
• Bloodborne Pathogens*
• Consumer Report Disclosure
• Dental Insurance Enrollment*
• DHS I-9 Employment Eligibility*
• EEOC Veterans Status*
• Health Insurance Enrollment*
• HIPAA Agreement*
• IRS Withholding Form W-4 2008
• MMR Declination Form
• OSHA Fire Safety in the Workplace
• OSHA Training Acknowledgment*
• Physician Statement*
• Rental Car Disclosure*
• Waiver of Health Insurance*
• Tax Home Status*
• Time Sheet*
• Varicella Waiver*
• Withholding/Deduction Authorization*
• Worker Compensation Notice*
Health and Dental Benefits Documents
• Health Insurance Coverages
• Health and Dental Insurance Premiums
• Dental Benefits - Dental Orthodontic Rider
Links
• Apply Online
• Home Page
• About StatGroup