Pre-employment / Pre-internship requirements

After an informal offer has been made but before your start date you will receive an offer letter which will include the terms of your employment and a copy of your position description.  Before your employment can begin you will need to complete certain pre-employment forms (found below).  These include authorization(s) for background checks, human resources form(s), and health records form(s).

General Documents:

  • DCF Background Check Authorization Form – After opening this link, check the bottom left corner of your computer screen for explanatory help text. Indicate ‘N/A’ in fields for which you have no information to enter. You must print and then sign this form and return it to Human Resources. You may also scan (at high resolution) and email the signed form to humanresources@cliffordbeers.org.
  • Medical Examination and PPD Form – Take this form to your health care provider or the facility the Clinic uses to document the results of these required tests.  Please contact one of the listed centers to schedule an appointment (2-5 days in advance).

Special documents for all staff who provide therapy:

  • Trauma Focused Cognitive Behavioral Therapy – Access the required online TF-CBT training. Click on the Register tab to get started. Print out the end-of-course certificate and return it to Human Resources. Call Vice President of Clinical and Community-Based Services Christine Montgomery, LCSW with any questions at 203-772-1270 x.1237.
  • National Provider Identifier (NPI#) – This important number enables the Clinic to bill for the services you provide. Click on the link in the center of the page to start, then click on ‘Apply Online For an NPI’ and apply as an individual provider. Please enter HR Manager (humanresources@cliffordbeers.org) as agency contact.
  • Credentialing Information Form – This form is used to obtain reimbursement from insurance companies.

If applicable, please also provide:

  • Copies of all licenses and certifications, e.g., LCSW, CPR
  • Copy of your latest, i.e., highest level, diploma