Application Form

To apply with W&W Healthcare, Inc., please download and print the forms below.  Return the completed forms to us by mail or FAX.

• Application for Employment

Required State & Federal Forms

• Form W4: Employee's Withholding Allowance Certificate

• Form IL-W4: Employee's Illinois Withholding Allowance Certificate

• Form I9: Employment Eligibility Verification

Other Required Documents

• HIPAA Patient Confidentiality Agreement

• RN Competency and Skills Checklist

• Physician's Statement

• Hepatitis B Vaccination Status

• Reference Form

• Workplace Safety / Criminal Background Check Authorization

• Drug and Alcohol Policy

• Employee Direct Deposit Bank Authorization

• Employee Weekly Time Sheet

To download forms on this page, left click on the links above and choose the "Save Target As..." option.  Adobe Acrobat Reader is required to open these forms.  If you don't have Adobe Acrobat Reader, you may download it for free.