Recruitment Process

The next step in the recruitment process:

A career with a healthcare organization requires that employers complete a thorough background check as well as provide you with an understanding on how that information will be used in conjunction with your experience, education, skills, and abilities to make hiring decisions.  

Below are the documents that are required for you to complete to initiate your background/reference check. 

Please complete and submit the following documents, which may be digitally signed. (Preferred Method) To complete:

  1. Click on the form link below. 
  2. Download the form and save to your computer. 
  3. Utilize Adobe Acrobat Reader to open, complete and digitally sign the form. [Adobe Acrobat Reader can be downloaded for free, click here.]
  4. Save the completed files to your PC. 
  5. Email the completed forms to

These documents may also be printed, manually completed, and submitted to


Required Information

Background Check Information   Requires completion and signature
Acknowledgment & Authorization for Background Check Requires signature
Disclosure Regarding Background Investigation Requires signature
Summary of Your Rights Under FCRA   Informational only – nothing to submit
Disclosure Statement – Application for Provisional Employment, Child Protective Service Law Requires signature


Upon receipt of these completed forms, Heritage Valley Health System will initiate the background check process.  When that background report is completed you will be contacted.  

If you have questions, please reach out to the Human Resources representative you have been working with:

Dan Snyder    412-749-7629   
Justin Sell    412-749-7691    
Traci Bayer     412-749-7789
Rosanne Cully  412-749-7603
Jamie Malloy 412-749-7019  


We look forward to speaking with you again soon!