Agency Employee Attestation Form for Hospitals

Form Template

The Agency Employee Attestation Form for Hospitals mobile app allows you to replace your paper attestation form with an iPhone, Android, tablet or desktop.

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The mobile form includes fields to document items such as agency, employer, employee, start date and orientation date. Once the mobile app is filled out a secure PDF is generated. The PDF is easy to share, and a copy is stored in your account for your human resources records. You can also use the App Builder to personalize and customize this mobile form. Employment agencies and human resource departments can use the app to ensure that requirements have been met prior to placing an employee. A completed background check. A valid drug screen by on file with the contracting agency. Completed Form I‐9 (Employment Eligibility Verification) with two acceptable forms of employment eligibility documentation as reviewed and verified by our qualified staff. Work history and education verification. Two current employment references and/or performance evaluations, to be sent with the application. Licensure and/or certification, if applicable Health screen documentation on file with the contracting agency.

  • Signature Capture
  • Submission Editing
  • Reference Data
  • Dispatch
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  • iPhone
  • iPad
  • Android
  • Windows
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  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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