Prior to your first day of orientation, you must complete a pre-placement health screen with Sentara Occupational Health. If you DO NOT have an appointment, call now to schedule (Monday - Friday 7:30 a.m. to 4 p.m. ).
Southside: (757) 261-6752
Peninsula: (757) 827-2153
Williamsburg: (757) 984-7438
Suffolk: (757) 934-4523
What to bring with you to this appointment:
DOWNLOAD and PRINT the CRIMINAL HISTORY FORMS ONLY. You do not need to print other forms. You may either complete electronically and print, or print and fill out by hand. Please DO NOT sign forms until you arrive for your health screening appointment.
At the time of appointment you must present a valid picture ID
You will need to bring an unexpired, government issued picture ID to the appointment. For most people this would be a driver's license, military ID card, or passport. If the name on your identification does not match the name on your application and social security card, please contact your recruiter to determine the best way to proceed. (Acceptable picture identification will be the same as indicated on the back of the I-9 form and must be current; if the identification you present is damaged and/or expired you will be unable to complete the pre-hire assessments).
Form Technical Details
You must have Adobe Reader to download these forms. Adobe Reader is free software that lets users view, fill and print filled in Adobe PDF files on all major computer platforms. Some of the forms are provided as "fillable" PDF files for your convenience. You must have at least Adobe Acrobat Reader 4.0 installed on your computer to view, complete and print fillable forms.
For "Fillable" PDF files: Acrobat Reader does not allow you to save what you key into the form, nor can you email the completed form—you should plan on completing and immediately printing completed forms. For some people, it may be easier to print and complete all of the forms by hand. You may do what works best for you.
Form 1: Criminal History form for Virginia (and Out-of-State form, if applicable)
For your safety and the safety of our patients, all employees are required to complete a criminal record release form allowing Sentara Healthcare to access your criminal record history. Forms must be accurately completed and will be notarized for you (if needed). Convictions listed on the criminal record not previously disclosed on your Sentara Healthcare Application for Employment may be grounds for withdrawal of your employment offer or termination of employment. All new hire candidates are required to give permission for Sentara Healthcare to request a criminal background check.
NOTE: Sentara will pay for this record request — you do not pay.
Instructions: Be sure to print the PDF of the Directions for filling out these forms, as they can appear complicated and the directions will assist with specific details. Open form in Adobe Reader, type in details within reader, print and bring to your Occupational Health Appointment (or submit as instructed by your Recruiter). If your Occupational Health appoint is less than 1 week prior to your start date, it is highly recommended that you find alternative means to get this form to your Recruiter as to not delay the process.
This form is to be completed by all Sentara Employees EXCEPT Sentara Life Care, Sentara Home Care, Sentara Mental Health Services and Medical Transport. (If you work for one of those location, please see forms below).
Criminal History Form
These forms are to be completed by the following new hires, SENTARA LIFE CARE, SENTARA HOME CARE, SENTARA MENTAL HEALTH SERVICES and MEDICAL TRANSPORT. If you have ever lived outside the state of Virginia, please fill out the "Out of State" form in addition to the Virginia form. This form will be notarized at the time of your pre-placement medical exam. Do not sign it until that time.
Detailed instructions for filling out the In State Criminal History forms
State Criminal History form
Out-of-State Criminal History form
Form 2: Pre-Placement Health Assessment
Must be completed by all new hire candidates. Your medical history will be reviewed with an Occupational Health nurse. 1) Click on the “Pre-Placement Health Assessment” form link below. 2) Answer all questions to the best of your ability. 3) Once all requested information has been completed on the form, select SUBMIT (located at the bottom of the form). You DO NOT need to PRINT these forms. 4) If you do not receive a confirmation notice that your health assessment was submitted successfully, print out the completed form and bring it with you to your appointment. 5) Call to schedule an appointment with Occupational Health:
Southside: (757) 261-6752
Peninsula: (757) 827-2153
Williamsburg: (757) 984-7438
Suffolk: (757) 934-4523
Pre-Placement Health Assessment form
What Else to Bring
Immunization records, including MMR (Measles, Mumps, Rubella), Hepatitis B, Varicella (Chickenpox) and Tetanus OR laboratory results of immune titers for Measles, Mumps, Rubella, Varicella (this information may be obtained from your physician or previous health care employer).
List of any prescription/non-prescription medications you are currently taking.
Documentation of your last TB skin test or chest x-ray report. This information may be obtained from your physician or previous health care employer.
If you have had a positive TB skin test in the past, bring your records related to treatment with INH from your personal physician or the public health department where you received treatment.
Picture ID (Acceptable picture identification will be the same as indicated on the back of the I-9 form and cannot be expired).
Important InformationPlease allow at least an hour to complete your health screen, and arrive at least 15 minutes prior to the time of your appointment.
To ensure their safety, Please DO NOT bring small children to your appointment.
You will complete a medical history, receive an assessment to determine your ability to do your new job, receive information about the Hepatitis B vaccine if required, receive a tuberculosis skin test if needed and receive other tests as required by the job offered.
You will also be required to complete a pre-employment drug test. Please DO NOT call the lab or Occupational Health about the drug screen results. If your drug screen is positive, a representative will contact you. If you are found to be ineligible for hire due to drug test results, you will be informed prior to your start date and you will be required to wait a minimum of 1 year before being considered for employment within Sentara.
For your safety and the safety of our patients, all new hires are required to complete a criminal record release form allowing Sentara Healthcare to access your criminal record history.
Please bring the completed form(s) to your appointment with Occupational Health where the document(s) will be notarized.
Convictions listed on the criminal record disclosed on your Sentara Healthcare Application for Employment, may be grounds for withdrawal of your employment offer or termination of employment.
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