| To
Register please Download and Fax your information
to: Fax: 718-769-2317 |
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| For Your Convenience you may Print and Complete this forms. | |||
| Registration Package | |||
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File Name |
Type | Size | |
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NYC EI Provider
Agreement 2011 With Appendix A
 |
3.4 Mb. | |
| (New Rev. 2011) | |||
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State Central Register Database Check | 41 Kb. | |
| (New Rev. 2009) | |||
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Contract
Individual Therapist (not incorporation) (New Rev. 2010) |
DOC | 43 Kb. |
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Contract Therapist with
Corporation (New Rev. 2010) |
DOC | 44 Kb. |
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Application for employment | DOC | 29 Kb. |
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Reference ( 2 required ) | DOC | 26 Kb. |
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Annual Health Assessment | DOC | 31 Kb. |
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Employment Eligibility Verification | DOC | 38 Kb. |
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Employment policy and procedures (New) | DOC | 34 Kb. |
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