• Headshot
  
• Current PA Nursing License or Compact License​
  
• Current PA Drivers License
• Current CPR certification
  
• PA Criminal Record Check
  
• Child Abuse Clearance
  
• FBI Finger printing for the Department of Education or Department of Public Welfare (use code: ​1KG6S7)
  
• Physical and PPD or Chest X-ray for positive PPD 
  
• ACT 24 Arrest and Conviction Report
  
• Independent Contractor Agreement, Profile, and Waiver
• W9 Form
• Clinical Competency Assessment and Validation Form
  
• ACT 168 form(s)​​
  
• ACT 126 Ethics Certification
• AUP Policy #815 Notification Form
  
• Bucks IU Non-Employee Contractor Signature Form
  
• BCIU Contractor Sign-off Confidentiality Form
  
• Narcan Certification
  
• Malpractice/Liability Insurance
  

Please click the following links for the forms listed below:

Required Documents and Credentials:

1. Accessing Act 126 Courses

2. Criminal Record Check

3. FBI Finger printing

​4. ACT 168 form

5. Child Abuse Clearance

6. ACT 24 form

​7. W-9 form

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2370 York Road, E-1          

  Jamison, Pa 18929             

Phone: 267-261-6609