Get Applicant, Staff And Resident Report - Arizona Department Of Health ... - Azdhs

This guide provides detailed steps to assist users in completing the Applicant, Staff And Resident Report required by the Arizona Department of Health Services. Follow these instructions to ensure accurate and efficient submission of the form online.

Follow the steps to successfully complete the report.

1. Click the ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by filling in the applicant or facility name in the designated field.
3. Enter the CDC/SGH number associated with your facility.
4. Complete the address section by providing the street address, city, and zip code.
5. In the section for 'Applicant', input the name of the person applying or the facility provider.
6. List all staff members currently employed at the facility. Ensure that anyone aged 18 years or older is included as they are required to be fingerprinted and registered.
7. For each staff member, provide their job title or relationship to the facility.
8. Indicate if they possess a high school diploma or GED and include the date achieved.
9. Record the hire date for each staff member.
10. Provide details regarding their fingerprint registration, clearance card expiration date, and the date the affidavit was completed.
11. Once all fields are filled out accurately, review your entries for completeness and correctness.
12. Finally, save your changes, and then download, print, or share the completed form as needed.

Begin filling out the Applicant, Staff And Resident Report online to meet your submission requirements.