TDY Medical Staffing, Inc.

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You will need the latest version of Adobe Reader to open these documents.  This program is free.  You may be able to electronically fill out the documents once opened, and save them on your computer if you have version 8.0 or higher.  Filling out these forms electronically is preferred as it is legible and easy to send.

Applicants:  Please fill out the application below.  If hired, we will instruct you to complete the documents under the NEW HIRES section.

TDY Medical Staffing Application

New Hires:  Please complete every form below.  Make sure to sign and date where applicable.  DO NOT fill out these forms until you have been instructed to do so.  Applicants do not fill these out until hired.

Back Brace Form

Health Status Statement Form
Hepatitis B Statement
Policy Substance Abuse

TB Screening Form
IRS Form W-4
IRS Form I-9
Hippa Manual 
Hippa Test
Hippa Agreement

Additionally, we will need a picture I.D., Social Security Card, Birth Certificate, BLS/ACLS (if applicable), PPD, transcripts when requested, Licenses (as required - MD, RN, PT, etc), other competencies/certifications required for your job.

VA Employees - VA Form 0711 is required

Current Employees - below are forms you may need at some point during your employment:

Timecard  Must be filled out every week by Noon on Monday.  Failure to complete on time may result in a delay in you getting paid.  You may electronically fill out the form on your computer using Adobe Reader - this will make your copy legible.  You can save the file on your computer if you have Adobe Reader 8.0 or higher.
IRS Form W-4  Fill out anytime you want to change your filing status.
Employee Incident Report - this form must be filled out for any incident that is considered out of the ordinary.  Examples - altercation with someone, patient fall/injury/medication error, no-call no show to facility, any disagreement with any persons at the facility you are assigned to work.

- In the event of a serious injury, seek emergency medical care first.  Contact us as soon as possible.  If it is not a medical emergency, please print the following documents and follow company policy for seeking medical treatment:
Employee Injury Report - Employee please fill this out as soon as possible
Claims Process
Medical Treatment Acceptance/Refusal Letter
Injury Reporting Packet

Workers Comp Info Poster

You must follow TDY Procedures/Policies regarding work place injuries.  Please contact us if you have any questions.

For questions regarding anything on this page, please email


TDY Medical Staffing, Inc. 2008-10®
All forms on this page are the property of TDY Medical Staffing, Inc. (except the IRS forms)