Student Information

Please submit the following information

**ONLY COMPLETE THIS INFORMATION PAGE ONCE YOUR PLACEMENT IS CONFIRMED**

Before completing this online information submission, take a moment to download, sign and scan the required documents in the tabs below. Please note that documents will not be processed by Reliant HR sooner than 30 days. Thank you for your interest in the Reliant Rehabilitation Student Program!

☐ Background check (within one year with all required criminal checks below – no exceptions!)

☐ State background required in CO, DE, FL, ID, IA, IL, IN, MA, MN, MO, OK, PA, SC, UT, VT, VA, & WI

☐ State background conducted by the facility in NV, NM, OR, RI (NV fingerprints are run onsite day one)

☐ CPR Certification (required in AZ*, IN*, MD*, MO*, NM*, NV, SC*, TX*, WI*)

☐ Drug Screen (ten-panel required in CA, CO*, DE, KS*, LA*, NV, & TX*)

☐ Fingerprints (required in AZ, DE, FL, IL, KS*, KY*, MN, MD, NC*, NV, & OK)

☐ Fire Safety Card (required in City of Los Angeles, CA)

☐ Flu shot (required in CA* & CO)

☐ Hepatitis B (proof or waiver required in NV & SC)

☐ MMR (proof or waiver required in MD & RI)

☐ Physical (required in CA, HI, IN, KS*, & NV)

Click “+” to expand.

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