Locum Tenens Orientation/Annual Training Acknowledgement Form

Locum Tenens Orientation/Annual Training Acknowledgement Form
By signing and submitting this form, I acknowledge that I have received and understand the provisions outlined in the Locum Tenens Orientation/Training information, and I agree to abide by these provisions. I will contact Medical Staff Services for additional information if needed.
Full Name

First NameLast Name
Signature
Date Acknowledgment Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty: