Employer onboarding

Service Agreement Acknowledgment & Onboarding Request

Review the agreement terms and provide your authorized acknowledgment. This is an agreement acknowledgment and onboarding request, not a final, legally binding e-signature. It creates no staffing agreement until ROMEL CAREPLUS, LLC reviews it and formally accepts it in writing.

Please do not enter patient health information. This form is for healthcare staffing only, never submit diagnoses, prescriptions, or private patient records.

Service Agreement Acknowledgment

Please review each section before signing. This is an acknowledgment and onboarding request, not a final, legally binding e-signature, and creates no staffing agreement until ROMEL CAREPLUS, LLC reviews and formally accepts it.

Facility / company name

Facility address

Authorized representative name

Representative title

Phone

Agreement date

Requested staff type

Authorized signature

Sign here

Type your full name to confirm

I confirm I am authorized to submit this agreement request on behalf of this facility.

I understand ROMEL CAREPLUS, LLC will review this submission and contact us before final activation.

Service Agreement Acknowledgment & Onboarding Request

Service Agreement Acknowledgment

1. Scope of Services

2. Screening & Qualifications

3. Rates & Billing

4. Review & Activation

5. Data & Privacy