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PLEASE PRINT THIS PAGE FOR REFERENCE
Thank you for your interest in working with Independent Nursing Services
Inc. We welcome you. As you probable know we have hundreds of positions
to choose from. You have chosen to apply for positions we have open
within the St. John Health System.
We will do our best to get you what you want.
In order to streamline the credentialing process we have put together a
list of steps that must be completed to provide services to St. John
Health. I assure you once this process is completed you will enjoy the
benefits that agency nursing has to offer.
Please fax copies of the following items to (586) 771- 4205 or scan and
e mail to
Dan@independentnursing.com
Current Resume
Copy of Current ACLS Certification for Critical Care Areas
Copy of Current BLS-Healthcare Provider
Copy of Current Ohio License
Copy of Hepatitis B vaccine validation or Signed/dated Vaccine
Consent/Decline release form (on file if electronic signatures
completed)
Copy of Ohio CIS License Verification or verification of skill/training
copy available at
Click here to go to RN and LPN License Verification http://nursing.ohio.gov/Verification.stm
Copy of Current TB Test or CXR results with signs and symptoms sheet
Copy of MMR Titers
TB Mask Fit (OR/PACU)
Recent Criminal Check
Picture ID
To complete the employment process we do need a few more forms signed by
you.
Please print and complete each document listed below and fax to our
office.
 Acrobat Reader is free from Adobe
(required for reading PDFs)
(Right Click, then "Save As" to save to your hard drive):
Please print sign and fax to (586) 771-4097
State of Ohio may require criminal background checks with
fingerprinting which can be done at your local police department. Drug
screening can be done at your local Concentra Office and coordinated
with us. Once all documents are received and reviewed a coordinator will
contact you with scheduling options.
Thank You.
Daniel Ochylski RN BSN
Independent Nursing Services Inc
dan@independentnursing.com
ph 586 771 4098
fax 586 771 4205
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