Forms

We’ve included all necessary employment forms below for both job seekers and official team members.

Get Hired!

Thank you for your interest in employment with Intrust Healthcare. Please complete the electronic job application, or print and complete the PDF version below. The PDF may be emailed to Intrust.Office@intrust-healthcare.com or faxed to 606-676-0789. You may also mail an application to Intrust Healthcare, 401 Bogle St., Ste. 102, Somerset, KY  42503.

If your qualifications meet our requirements, a representative from our Human Resources Department will contact you.

Forms
Application for Employment
Forms
Central Registry Check
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Reference Release Form
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Request For Reference
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State Background check

You're Hired!

Welcome to our Intrust Healthcare team! Now, let’s get started. Please print each form, complete, and bring to the orientation class. If you have any questions, please contact Katie Palmer at katie.palmer@intrust-healthcare.com.

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Automatic Payroll Deposit Authorization
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Back Belt Policy
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Communicable Disease Record
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Computer Usage Policy
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Confidentiality Statement A
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Confidentiality Statement B
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Documentation Return
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Emergency Contact Sheet
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Employee Handbook Acknowledgement
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Employee Health History
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For Office Use Only
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Human Resources Action Form
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I-9
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K-4
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Liability Clause
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Non-Competition Agreement
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Privacy Practices
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Statement of Disclosure
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W-4