For New Employees

For your convenience, we have provided the forms you will need for your Human Resources orientation, as well as information about benefits. Please print and complete the applicable forms  listed below, and bring them to Human Resources prior to your orientation. 

Contact Human Resources if you have any questions.

If you cannot open these files, click here to download Acrobat Reader.

SECTION 1
The following documents are required for all new employees. 

• I-9 Employment Eligibility Verification
• W-4 Form: Employee Withholding Allowance
• Automobile Policy No. 3.17
• Automobile Policy Agreement
• Client/Guardian Request to Restrict Disclosures of Protected Health Information (PHI) Policy No. 403
• Confidentiality Oath, Ethics Policy and Protected Health Information (PHI) Policies Acknowledgement form and Ethics Acknowledgement
• Confidentiality Policy No. 8.00
• Documentation and Reporting of Protected Health Information (PHI) Disclosures Policy No. 404
• Degree(s) Verification
• Drug and Alcohol Policy No. 3.08
• Election Form and Salary Reduction Agreement
• Emergency Contact Form
• Employment Application
• Equal Opportunity Policy No. 3.00
• Equal Opportunity/Drug and Alcohol Policy Receipt
• Ethical Conduct Policy No. 8.02
• Hepatitis B Form
• ID Badge Policy
• MHRH Database Form
• Minimum Necessary Access of Protected Health Information (PH) by Staff Policy No. 405
• Staff Code of Ethics
• Policies Acknowledgement

SECTION 2
For new employees working in Child & Family Services/The Providence Center School:

• Summary of required documents
• Summary of required documents only for employees of The Providence Center School
• DCYF Clearance Request/Results
• DCYF Criminal Records Affidavit
• DCYF Employment History Affidavit
• Certificate of Teaching Service

SECTION 3
For new employees working in Community Support Services:

• Summary of required documents

SECTION 4
For new nurses:

• Summary of required documents

SECTION 5
For new employees working in the substance abuse program:

• Summary of required documents

SECTION 6
Other documents:

• 2010 Holiday Schedule
• 403(B) Plans Overview
• 403(B) Salary Reduction Agreement
• Direct Deposit Form
• Life Assistance Program

SECTION 7
Benefits Information:

• Delta Dental Highlights
• Health Care & Dependent Care Plan Overview
• Health Care & Dependent Care Reimbursement Enrollment Form
• Health Care & Dependent Care Reimbursement Handbook
• Health Care & Dependent Care Reimbursement Highlights
• Tuition Assistance
• Waiver of Health Insurance

SECTION 8
Credentialing Applications:

• Application for Beacon Credentialing
• Application for Magellan Credentialing
• Application for New Medicare Credentialing - CMS855I
• Application with Previous Medicare Number - CMS855R
• Medicaid application
• UBH Provider Application
• NPI Application