Healthcare AD Resources

New Customer and New Assignment Forms

New Customer Summary (NCS) - Online Form. The NCS needs to be Completed and Submitted by AD for all New Customers for USA Approval prior to any staffing.  Please complete this form with as much detail as possible for the prospective Customer and Assignment. Please note: If there are multiple assignments/position types for this Customer, please include 1 assignment on this form and complete a Quote Request Form (QRF) for each additional assignment(s).

Quote Request Form (QRF) - Online Form. The QRF needs to be Completed and Submitted by AD for all New Assignments for USA Approval and Quote prior to any staffing.

Business Trade Reference Form (TRF) - Download pdf. The TRF may need to be completed by Customer if further information is needed for USA to determine credit worthiness.

Healthcare Candidate Submittals

Healthcare Submittal Form (HSF) - Online Form. The HSF needs to be completed and submitted by AD for all healthcare candidate submittals
Candidate Reference Form - Download pdf. The form needs to be completed and submitted with the Healthcare Submittal Form.

New Hire & Onboarding Documents

New Hire & Onboarding Documents will be completed electronically via the USA Onboarding Portal.  Once you have completed and submitted a New Hire Summary (link below), the Employee(s) will be emailed an Onboarding Portal link by your Staffing Coordinator.   As an AD you will be responsible for completing Page 2 of the Form I9 – See link below for page 2 of the Form I9.
New Hire Summary (NHS) - Online Form. The NHS need to be completed and submitted by AD for all new temp/contract hires.  If you have multiple new hires with the same assignment details (job title, pay rate and bill rate) you can list multiple employees on one form.

Healthcare Screen Request Form (SRF) - Online Form. USA performs pre-employment background screens on all employees.  If your customer requires specific pre-employment screens you can complete and submit the Screen Request Form.

Form I9 - Page 2 & Supporting Docs Lists - Download pdf. The AD is responsible for completing Page 2 of the Form I9.  You can download the form here to complete sign and return or you can contact your Staffing Coordinator to email you a DocuSign version of the Form I9 to complete and sign electronically. Click here to email request

Form I9 - Sample Completion Guide - Download pdf. The AD is responsible for completing Page 2 of Form I9 – This shows you how

Form I9 List B Docs - Driver License State Issuers - Download pdf. If the employee presents a driver’s license for a List B doc, be sure you have the correct state issuing authority for Driver’s Licenses.

Health Insurance Information - link. USA offers ACA compliant healthcare plans to all of our employees.

Employee Portal Instructions. All employees have access to an Employee Portal to view pay stubs, onboarding documents and more.

AD Manual - Operating Policies & Procedures. USA Staffing Services’ Operating Policies and Procedures Manual for Authorized Dealers.

Direct Hire Summary (DHS) - Online Form. The DHS needs to be completed and submitted by AD for all new Direct or Permanent Hires.

Please contact a Staffing Coordinator with any employee onboarding questions

Ivonne Orjuela Payroll and Staffing Coordinator 813.518.6583

Sandra Mateo Payroll Manager 813.518.6580

Approved Customer and Assignment Agreements

New Hire & Onboarding Documents

Your Account Manager will prepare and send all Agreements directly to Customer via DocuSign. Each new customer will require one executed Terms and Conditions of Assignment Agreement.  Each Assignment type will require a seperate Assignment and Bill Rate Summary.  You can contact your Account Manager by clicking their email or phone below.  You can also complete Agreement Request Form by clicking here.

If your Customer requests we us their Agreement in place of ours, please email a copy to your Account Manager for review and approval by USA’s Legal Dept.

David Ellison Account Manager 813.518.6587