Human Resources Team Page - Progressive Institute

Welcome!

Please select the resource you wish to access below.

1Welcome!

2Personal

3Credentialing

4HR

5TPI

6Forms

Welcome to Progressive Institute!

We're glad you've decided to join our team. This form will walk you through everything needed to get you started. Please begin by answering the following questions. If you need any help along the way, please don't hesitate to give us a call. NOTE: You must complete this form in one sitting, your progress will not be saved if you close the page and come back later.

Are you going to be a part-time or full-time employee? *

Full-Time W2 (Employee)
Part-Time W2 (Employee)
Part-Time 1099 (Contractor)
Intern or Volunteer

What position have you been hired for? *

Clinical Staff Categorization

Clinical

Staff Categorization (you do not need to do anything here)

Psychiatric Staff Categorization

Psychiatric

Staff Categorization (you do not need to do anything here)

Other Staff Categorization

Other/Office

Staff Categorization (you do not need to do anything here)

Documents to Prepare

The following is a list of documents that you will be asked to upload during the onboarding process. If you do not have one or more of these documents, need time to collect them, or have already submitted them, please mark each below. You will be required to upload any documents left unchecked (which ideally is all of them) in order to submit this form. The documents listed below the checkbox items are not optional and must be uploaded to complete the form.

Documents to Prepare (Psychiatric)

Diploma
CT Provider License
CSP Registration
DEA Certificate
Certificate of Insurance
Letters of Reference (3)
Health Screening Report (inc. proof of PPD Test and Flu Vaccine)

Other Documents
Resume
Driver's License
Passport or Social Security Card
Form W-4 (W2)
Form CT-W4 (W2)
Form W-9 (1099)
Form I-9
Form DCF-3031
Form DPS-0846-C
Beacon Account Request Form
Progressive Diagnostics NCF

Documents to Prepare (Clinical)

Diploma
CT Provider License
Certificate of Insurance
Letters of Reference (3)
Health Screening Report (inc. proof of PPD Test and Flu Vaccine)

Other Documents
Resume
Driver's License
Passport or Social Security Card
Form W-4 (W2)
Form CT-W4 (W2)
Form W-9 (1099)
Form I-9
Form DCF-3031
Form DPS-0846-C
Beacon Account Request Form

Documents to Prepare (Other/Office)

Letters of Reference (3)
Health Screening Report (inc. proof of PPD Test and Flu Vaccine)

Other Documents
Resume
Driver's License
Passport or Social Security Card
Form W-4 (W2)
Form CT-W4 (W2)
Form W-9 (1099)
Form I-9
Form DCF-3031
Form DPS-0846-C

Demographics

Name *

First

Last

Start Date *

Date of Birth *//

Birth City, State, Country *

Social Security Number *

Phone *

Email *

Address *

Address Line 1

City

State

Zip Code

Document Uploads

Please upload the following identifying documents.

Resume *

Click or drag a file to this area to upload.

Please upload a current copy of your resume.

Driver's License *

Click or drag a file to this area to upload.

Passport or Social Security Card *

Click or drag a file to this area to upload.

Credentialing

Nothing for you to complete here! Please upload your letters of reference and any applicable certifications below, then proceed to the next page.

Degree *

NPI Number *

Click here to lookup your NPI and taxonomy identifiers. If NPI information is not known, please call 1‐800‐465‐3203 to obtain.

Specialty/Taxonomy *

Specialty/Taxonomy

NPPES Username

NPPES Password

Do not have NPI

I do not currently have an NPI Number.

CT Provider License Number *

Click here to lookup your state license and/or CSP number.

License Expiration Date *

License Expiration Date

Do not have a provider license

I do not currently have a CT provider license.

Controlled Substance Practitioner Registration *

Click here to lookup your state license and/or CSP number.

CSP Expiration Date *

CSP Expiration Date

DEA Registration Number *

DEA Expiration Date *

DEA Expiration Date

Medicaid Number *

DSS Username

DSS Password

Do not know or have medicaid number

I do not know or I do not have a Medicaid ID Number.

CAQH ID Number *

If CAQH information is not known, please call 888-599‐1771 to obtain.

CAQH Username

CAQH Password

Do not know or have CAQH ID

I do not know or I do not have a CAQH ID Number.

Professional Malpractice Policy Number *

Malpractice Expiration Date *

Malpractice Expiration Date

Do not have insurance

I do not currently have professional malpractice insurance.

Document Uploads

Please upload the following credentialing documents.

Diploma *

Click or drag a file to this area to upload.

Please upload a copy of your diploma.

CT Provider License *

Click or drag a file to this area to upload.

Please upload a copy of your Connecticut state license.

CSP Registration *

Click or drag a file to this area to upload.

Please upload a copy of your CSP registration.

DEA Certificate *

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload a copy of your DEA certificate. Please also include your Suboxone DATA waiver, if applicable.

Certificate of Insurance *

Click or drag a file to this area to upload.

Please upload a copy of your general malpractice insurance certificate.

Letters of Reference *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload three professional letters of reference.

Trainings and Certifications

Click or drag files to this area to upload. You can upload up to 5 files.

Please use this field to upload any additional trainings, CEUs, certifications, licenses or degrees that your hold. Examples include First AID/CPR certification, Narcan training, Suboxone DATA Waiver, Trauma-Informed Care certificate, etc.

Direct Deposit

Name of Financial Institution *

Routing Number *

Account Number *

Account Type *

Checking
Savings

Voided Check

Click or drag a file to this area to upload.

Please upload a voided check or deposit slip.

Direct Deposit Signature *

Primary Account Holder Authorized Signature

Emergency Information

Emergency Procedures

In the event of a medical emergency, are there any emergency procedures or restrictions on medications of which emergency personnel should be aware? If yes, please explain.

Primary Emergency Contact *

Phone Number *

Secondary Emergency Contact

Phone Number

Physician Contact

Phone Number

Business Associate Agreement

Click here to review the BAA, then sign below.

Business Associate Agreement *

I acknowledge that I have read and understand the Business Associate Agreement and will comply with all provisions contained therein.

Employee Handbook

The employee handbook contains valuable information about the policies and procedures of the organization. Please review it carefully and then sign the acknowledgment below. The handbook can be accessed at any time on the company team pages.

Click here to review the Employee Handbook, then sign below.

Acknowledgment of Receipt of Employee Handbook *

I have received the current Company employee handbook and have read and understand the material covered. I understand that any questions that I may have about the handbook or its contents will be answered by my supervisor. I agree to and will comply with the policies, procedures, and other guidelines set forth in the handbook. I understand that the Company reserves the right to change, modify, or abolish any or all of the policies, benefits, rules, and regulations contained or described in the handbook as it deems appropriate at any time, with or without notice. I acknowledge that neither the handbook nor its contents are an express or implied contract regarding my employment.

I further understand that all employees and contractors of the Company, regardless of their classification or position, are employed on an at-will basis, and their employment is terminable at the will of the employee or the Company at any time, with or without cause, and with or without notice. I have also been informed and understand that nothing contained in the policies, procedures, handbooks, or any other documents of the Company shall in any way create an express or implied contract of employment or an employment relationship other than one on an at-will basis.

Progressive Institute Policies and Procedures

Please click the link to review each of the following documents, which outline important policies, procedures and training material. When finished please sign your name in the signature box below each linked document.

Job Description - Medical Director

Click here to view, then sign below.

Job Description - Nurse Practitioner

Click here to view, then sign below.

Job Description - Office Admin & Clinical Support

Click here to view, then sign below.

Job Description - Primary Therapist

Click here to view, then sign below.

Job Description - Primary Therapist

Click here to view, then sign below.

Job Description - Student Intern (Master's Level)

Click here to view, then sign below.

Job Description - Student Intern (Bachelor's Level)

Click here to view, then sign below.

Job Description Signature *

I will abide by all laws controlling the privacy of, access to and maintenance of confidential information, including, but not limited to, the federal Health Insurance Portability and Accountability Act (HIPAA), the federal confidentiality law (42 CFR Part 2) and Connecticut Public Health Law. I have reviewed this job description and understand all of my duties and responsibilities. I am able to perform the essential functions as outlined. I understand that my job may include tasks that are not specifically included in the job description to better serve the needs of the organization. If I have any questions about job duties not specified on this description that I am asked to perform, I should discuss them with my immediate supervisor or Human Resources. I further understand that future performance evaluations and merit increases to my pay are based on my ability to perform the duties and responsibilities outlined in this job description to the satisfaction of my immediate supervisor.

Policy and Procedure Overview

Click here to view, then sign below.

SOP Overview Signature *

I have read and understand the following policies and procedures of The Progressive Institute: a. Anti-Harassment & Sexual Harassment Policy; b. Whistleblower Policy; c. Computerization Policy; d. Confidentiality Agreement; e. Formal Grievance Procedures; f. Substance Abuse Policy; and g. Client Rights. As an employee of the organization, I agree to abide by these policies and report any violations to the appropriate parties as indicated. I further understand that any violation of these policies may result in disciplinary action up to and including dismissal and that violation of any federal or state laws may be reported to any and all necessary authorities.

Employee Rights and Responsibilities

Click here to view, then sign below.

Employee Rights/Resp. Signature *

I have read and understand my rights and responsibilities as an employee of the organization.

Emergency Management Plan

Click here to view, then sign below.

EMP Signature *

I have read and understood the Progressive Institute’s Emergency Action Plan. In the event of any of the emergencies outlined in this plan, I will follow the indicated procedures to the best of my ability. I understand that I am not to perform any tasks where training is required unless I have completed the required trainings (i.e., First Aid/CPR, use of fire extinguishers, Narcan Administration, etc.).

Code of Ethics

Click here to view, then sign below.

Code of Ethics Signature *

I have read and understand the Progressive Institute’s Code of Ethics. I understand that I am expected to abide by these ethical guidelines and that violation of these standards shall result in disciplinary action by the organization up to and including dismissal.

Acknowledgment of HIPAA & 42 CFR Part 2

Click here to view, then sign below.

HIPPA Acknowledgment *

I have read and understand the organization's policies pertaining to HIPAA and 42 CFR Part 2. By signing below I am acknowledging that it is my responsibility to adhere to these policies.

Cultural Competency Training

Click here to view, then sign below.

Cultural Competency Training *

I acknowledge that I have read and understand the components of cultural diversity outlined in this document and will comply with all provisions contained therein.

New Hire Forms

Please click the link to download and complete each of the following forms. To the extent you are able to, we ask that you fill out the forms electronically, then print and sign them (e-signing may be possible depending on your computer software). When finished, please upload the forms to the appropriate field indicated below.

Form W-4 *

Click or drag a file to this area to upload.

Access form here

Form CT-W4 *

Click or drag a file to this area to upload.

Access form here

Form W-9 *

Click or drag a file to this area to upload.

Access form here

Form I-9 *

Click or drag a file to this area to upload.

Access form here

Form DCF-3031 *

Click or drag a file to this area to upload.

Access form here

Form DPS-0846-C *

Click or drag a file to this area to upload.

Access form here

Progressive Diagnostics NCF *

Click or drag a file to this area to upload.

Access form here

Health Screening Report *

Click or drag files to this area to upload. You can upload up to 3 files.

Access form here. Please also include proof of flu vaccination and PPD test results. These can be uploaded as separate documents or indicated on the health screening report by your physician.

DPH Certificate by the Director*

Click or drag a file to this area to upload.

Access form here. *Please note that this form must be notarized before uploading.

1Start Here

2Complete Trainings

Company *

Name *

Please select all of the trainings you wish to complete. *

Active Shooter
Child Abuse and Neglect
Code of Ethics
Confidentiality and HIPAA
Cultural Competency
De-Escalation
Elder Abuse and Neglect
Emergency Management Plan
Employee Rights and Responsibilities
Environment of Care Plan
General Policies and Procedures
Infection Control Plan
Suicide Awareness and Prevention
Trauma-Informed Care

Active Shooter

Click here to review the training, then sign below.

Active Shooter *

I acknowledge that I have reviewed and understand the training material on what to do in the event of an active shooter.

Child Abuse and Neglect

Click here to review the training, then sign below.

Child Abuse and Neglect *

I acknowledge that I have reviewed and understand the training on child abuse and neglect.

Code of Ethics

Click here to review the training, then sign below.

Code of Ethics *

Confidentiality and HIPAA

Click here to review the training (1/3), then sign below.
Click here to review the training (2/3), then sign below.
Click here to review the training (3/3), then sign below.

Confidentiality and HIPAA *

I acknowledge that I have read and understand my responsibilities to preserve and protect the confidentiality and security of all medical records and other confidential information relating to the organization, its clients, activities and affiliates, in accordance with federal and state laws as well as organization policy. I have read and understand the organization's policies pertaining to HIPAA and 42 CFR Part 2. By signing below I am acknowledging that it is my responsibility to adhere to these policies.

Cultural Competency

Click here to review the training (1/2), then sign below.
Click here to review the training (2/2), then sign below.

Cultural Competency *

I acknowledge that I have read and understand the components of cultural diversity outlined in this document and will comply with all provisions contained therein.

De-Escalation

Click here to review the training, then sign below.

De-Escalation *

I acknowledge that I have reviewed and understand the training on client de-escalation.

Elder Abuse and Neglect

Click here to review the training, then sign below.

Elder Abuse and Neglect *

I acknowledge that I have reviewed and understand the training on elder abuse and neglect.

Emergency Management Plan

Click here to review the training, then sign below.

Emergency Management Plan *

Employee Rights and Responsibilities

Click here to review the training, then sign below.

Employee Rights and Responsibilities *

I have read and understand my rights and responsibilities as an employee of the organization.

Environment of Care Plan

Click here to review the training, then sign below.

Environment of Care Plan *

I acknowledge that I have reviewed and understand the company's environment of care policies.

General Policies and Procedures

Click here to review the training, then sign below.

General Policies and Procedures *

Infection Control Plan

Click here to review the training, then sign below.

Infection Control Plan *

I acknowledge that I have reviewed and understand the company's infection control plan.

Suicide Awareness and Prevention

Click here to review the training, then sign below.

Suicide Awareness and Prevention *

I acknowledge that I have reviewed and understand the training on suicide awareness and prevention.

Trauma-Informed Care

Click here to review the training, then sign below.

Trauma-Informed Care *

I acknowledge that I have reviewed and understand the training on trauma-informed care.

Company *

Name *

Would you like your current PTO information emailed to you after completing this form? *

Just want details on your current PTO? Select Yes and leave the slider set to 0 Days.

How many business days are you requesting off?

PTO Request: 0 day(s)

Enter Date(s) *

PTO Day
Floating Holiday

Enter Date(s) 2 *

Full or Half 2 *

PTO Day
Floating Holiday

Enter Date(s) 3 *

Full or Half 3 *

PTO Day

Enter Date(s) 4 *

Full or Half 4 *

PTO Day

Enter Date(s) 5 *

Full or Half 5 *

PTO Day

Enter Date(s) 6 *

Full or Half 6 *

PTO Day

Enter Date(s) 7 *

Full or Half 7 *

PTO Day

Enter Date(s) 8 *

Full or Half 8 *

PTO Day

Enter Date(s) 9 *

Full or Half 9 *

PTO Day

Enter Date(s) 10 *

Full or Half 10 *

PTO Day

Notes for Supervisor/Approver

Click here to access the TPI Sharepoint Homepage . You must be an active employee to access this resource.

Select your email address below and click submit to have your testing record and vaccination card(s) emailed to you.

Email Address *

Vaccine card

Need to submit or update your vaccine card(s)? Click here to upload!

Vaccine Card Upload *

Click or drag a file to this area to upload.

Note: If you have more than one vaccine card, please combine them into a single document before uploading.

Welcome!

Complete New Employee Onboarding

Demographics

Document Uploads

Credentialing

Document Uploads

Direct Deposit

Emergency Information

Business Associate Agreement

Employee Handbook

Progressive Institute Policies and Procedures

Job Description - Medical Director

Job Description - Nurse Practitioner

Job Description - Office Admin & Clinical Support

Job Description - Primary Therapist

Job Description - Primary Therapist

Job Description - Student Intern (Master's Level)

Job Description - Student Intern (Bachelor's Level)

Policy and Procedure Overview

Employee Rights and Responsibilities

Emergency Management Plan

Code of Ethics

Acknowledgment of HIPAA & 42 CFR Part 2

Cultural Competency Training

New Hire Forms

Access Employee Trainings

Active Shooter

Child Abuse and Neglect

Code of Ethics

Confidentiality and HIPAA

Cultural Competency

De-Escalation

Elder Abuse and Neglect

Emergency Management Plan

Employee Rights and Responsibilities

Environment of Care Plan

General Policies and Procedures

Infection Control Plan

Suicide Awareness and Prevention

Trauma-Informed Care

Submit a PTO Request

Access Employee Resources (SharePoint Homepage)

Retrieve Vaccination & Testing Record

Give us a call.