Welcome to CCI.
To begin the submission process, to either become a travel therapist or a local contractor, you will have to first complete the onboarding documents. Below we have listed all the necessary documents in the order needed. The documents are fully writable PDF’s to help simplify the credentialing process. Once you have completed the document, select the “Submit Response” option and the document will be sent directly to your therapist advocate.
To submit any additional documents, please email a PDF copy to your therapist advocate or fax the documents to (301) 657-5651. Please do not email pictures, unless they are clear. If needed, please download a scanner app for your mobile device.
If you have any questions or concerns, please contact your therapist advocate by phone at toll-free 1-877-221-2981 or local to the DC/Baltimore Metro Area (301) 337-6921.
Onboarding Paperwork
Current Resume in Word Document Format
Skills Checklist that pertains to your specialty (please reach out directly for RN/RT skills checklists):
Two Professional or Supervisory References – Please complete the top portion of the Reference form and “Submit”. Your Therapist Advocate will reach out to the reference in order to complete the remainder of the form.
New Employee Handbook – Read each page carefully, initial at the bottom of each page, and sign & date the last page.
New Travel Therapist or Local Contractor Paperwork
Two forms of identification (Driver’s License, Passport, SSN Card, or Birth Certificate).
Signed copy of your current therapist license, for the state where you will be practicing.
Copy of your current CPR Certification (front and back of signed card).
NPI Number – If you do not have an NPI number, please register online by visiting: https://nppes.cms.hhs.gov/NPPES/Welcome.do
CrimCheck Background Authorization Form
Medical Paperwork
Statement of Satisfactory Health – Must be dated within the last year, must state “free of communicable diseases” and must be signed by a primary care physician.
Proof of Vaccinations:
- MMR Vaccination or Titer record
- Varicella Vaccination or Titer record
- Influenza Vaccination or Declination
- Hepatitis B Vaccines, Titer, or Declination
- PPD – Must be within the last year (documentation should state the date placed, date read, result, lot number, and expiration date of serum)
Vaccine and Titer Documentation
Tuberculosis Annual Health Questionnaire
Legal Paperwork
HIPPA, Joint Commission, and Injury & Exposure Acknowledgement Forms
Employee Direct Deposit Enrollment Form
Form I-9 – Complete the first page only.
2020 Federal Withholding Form (W-4)
2020 State Withholding Form:
