Affiliate On-Boarding Documents
The forms below are intended for use by MAHEC Affiliates prior to their start date. Affiliate relationships include, but are not limit to: students, learners, observers, contractors, or vendor representatives.
Please complete items 1, 2 and 3 shown below. Item 2 contains (2) separate articles that need to be completed. Item 4 is only required if Affiliate is under the age of 18. Once completed, submit to your MAHEC Host Representative directly.
- MAHEC Affiliate Application Packet
- Background Investigation documents — Please review and sign document A and complete article B.
- Criminal History Self Disclosure (signature required)
- Background Screening: Upon acceptance of your application, you will receive a background screening request from our provider "CRC" Criminal Record Check. Once completed, your MAHEC host will be notified.
- COVID-19 Screening Form - must be completed by all Affiliates at the time of onboarding.
- MAHEC Minor Consent and Release Form (Required only if under age 18)
- Affiliate COVID-19 Travel Form - to be completed every time the affiliate goes anywhere overnight and/or attends any gathering.
- Request for Medical Exemption from Influenza Vaccination
- Request for Religious Exemption from Influenza Vaccination
- Authorization to Publish Photograph on MAHEC Sites
- Procedure for Drug-Screening Laboratory Information
- Consent and Notice of Release of Liability for Controlled Substance Testing
- N.C. Controller Substance Examination Regulation Act Initial Notice to Employees
If you are a health sciences student working with the Office of Regional Primary Care Education (ORPCE),
please email your completed forms to the ORPCE Program Coordinator at Jasmine.firstname.lastname@example.org or call (828) 407-2599 to make other arrangements.
If you are affiliated with another program and have any questions about these forms, please contact your MAHEC Host Representative or Talent Management email@example.com.