SIGNATURE BLOCK ON FOLLOWING PAGE. This Agreement and attached Assignment Confirmation contain terms that may only be altered when agreed upon in writing by both parties.
SIGNATURE BLOCK ON FOLLOWING PAGE. This Agreement contains terms and conditions that may only be altered when agreed upon in writing by both parties, (Please return all pages of this Client Services Agreement).
SIGNATURE BLOCK ON FOLLOWING PAGE. This Agreement and attached Assignment Confirmation contain terms that may only be altered when agreed upon in writing by both parties. (Please return all pages of this Client Services Agreement) Client Representative Signature Date Soliant Representative Signature Date Print Name Print Name Title Title Client: PENN DELCO SCHOOL DISTRICT City, State: Will the contracted professional be permitted to attend Orientation while license is in process? YES NO Will the contracted professional be permitted to start their assignment while license is in process? YES NO In an effort to provide all necessary documentation for travel healthcare professionals assigned to your facility, we ask that you complete this form to be used as a reference for all personnel placed in your facility. Standard Credentialing Package As part of our Standard Credentialing Package, Soliant will provide the following prior to the start of a contracted assignment. PROFESSIONAL: Current CV / Resume Current Skills Checklist, if applicable References LICENSURE Professional License, as applicable Professional Certification, as applicable License and/or Certification Verification EDUCATION: CDC Guidelines for School Professionals FERPA Guidelines BACKGROUND: Criminal Background Check GSA Exclusion Search HHS/OIG Search Sexual Offender Search MEDICAL: Hepatitis B Vaccination / Declination form MMR Declination Physical Examination Waiver 10-Panel Drug Screen Optional Credentialing If your district requires any additional credentialing items above what is contained in the Standard Credentialing Package, please indicate below. If no additional items are noted, the Standard Credentialing Package will be provided. Credentialing Documents will be held on file at Soliant and unless specifically requested, will not be forwarded to Client.
