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| License Verifications | form |
| Employment Verifications | for past 5 years w/ form |
| Staff Privileges Verifications | for past 5 years w/ form |
| AMA / AOA Profile | |
| NPDB / HIPDB Report | |
| Number of Reference Letters | 2 form with photo and notary |
| Background Check | $18 Get fingerprint cards from Local PD. Federal Bureau of Investigation Criminal Justice Information Services Section Attn: Records Request 1000 Custer Hollow Road Clarksburg, WV 26306 |
| Photo | 1 for use on application |