Professional Credentials

Please attach the following when submitting this Application:


1. CA Professional License – Front and Back copies with signature

2. Driver’s License

3. BLS/CPR – Front and Back copies with signature. American Heart Association for healthcare provider

4. ACLS,PALS,MAB,EKG/ARRYTHMIA Certification as Applicable/Back should be signed, AHA provider

5. Diploma (Hospital requirement for education verification)

6. Physician Statement, taken within the last 12 months, *Physician Statement with Signature of M.D

7. Chest X-Ray or PPD Test

8. Drug Screen

9. Immunization Records (MMR and Varicella)

• TB/PPD Test

• Rubella Titre, Rubeola Titre, Mumps Titre

• Vaccine Zoster Titre, Immunity by History of Disease as Verified by MD and Vaccination

• Covid-19

10. Hepatitis B Declination, Proof of Series, or Titre Showing Immunity.
Max. file size: 64 MB.