ScheduleFlex Help

Registration: AHG & Pathways Wellness Program Shiftboard

If you have not yet registered for access to our online scheduling system, please complete the following form.

* required field
APPLICANT INFORMATION
 

License Information
License Type
RN
LPN
Phlebotomist
Dietician
Massage Therapy
Other
Professional License Expiration Date
Professional Liability Insurance Expiration Date

Documents/Checklist
Last TB test completed
Chest X-Ray Expiration Date
CPR Expiration Date
Act 33 - Child Abuse Clearance Expiration Date
Act 34 - (PATCH) Expiration Date
Act 73 - Fingerprinting Expiration Date
Drivers License Expiration Date
Car Insurance Expiration Date
Mandated Child Abuse Reporting Expiration Date

Emergency Contact
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relationship
Emergency Contact Second Number
Emergency Contact #2 Name
Emergency Contact #2 Phone
Emergency Contact #2 Relationship
Emergency Contact Second Number #2

We store cookies and other data on your device to help us deliver our services. By using Shiftboard, you agree to our use of cookies and confirm that you have read and accept our privacy policy.  



Thank you for your interest!
 
 

×
Loading...
Loading...
Loading...
Getting help...

Error

×