New Clinician - Onboarding

Please correct the errors described below.

Training Session:

Name:

Add a new record for each title

Date of Birth:

Address:

Phone Number:

E-Mail:

DL:

SSN:

9 Digits, No Dashes

CV/Resume

Licensure Type

Credentials:

Council for Affordable Quality Healthcare

Liability Insurance:

Please note: Seed Digging, PLLC must be included on the policy.

Workers' Compensation

Please fill out an AR-A form using the link below. Then, upload the completed copy to this form.

**The clinician will be responsible for:

  • having this document notarized and any fees that may be associated
  • sending to the Arkansas Workers' Compensation Commission
  • the requested payment for filing

Once the certificate of non-coverage is received, please e-mail a copy to reception@seeddigging.com.

Please note: Seed Digging, PLLC must be included on the policy.

Seed Digging, PLLC Agreement

Sub-Contractor Agreement

Please bring in a signed copy of the sub-contractor agreement to your training session. You may also email a copy to reception@seeddigging.com (Please note: This MUST be a PDF or Word document ONLY).

Intern Agreement

Please bring in a signed copy of the intern agreement to your training session. You may also email a copy to reception@seeddigging.com (Please note: This MUST be a PDF or Word document ONLY).

Website Information

Working Schedule

*By typing your name and date below, you are signing this document electronically. You agree that your electronic signature is the legal equivalent of your manual/handwritten signature on this application. By typing your name and date below you are certify the information you provided on and in connection with this form is true and correct to the best of your knowledge.

Your information will be encrypted.

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