SCI Provider Application










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If you answer yes to any of the following, please provide an explanation, along with any necessary supporting documents. Please use the File Upload feature at end of form to upload any supporting documents.


Please upload a document or zipped folder containing your CV or resume, and additional supporting documents requested by your recruiter or SCI Credentialing Department. Total files uploaded must be less than 5MB, allowed file types are zip, pdf, doc, docx, rtf, jpg.
Click or drag files to this area to upload. You can upload up to 5 files.
I certify that my answers are true and complete. If this application leads to employment, I understand that false or misleading information in my application may result in my dismissal. SCI Anesthesia Services, and its representatives are hereby authorized to make any investigations of my personal and professional history through any agency or bureau necessary, including verification background checks, E-verify, degree verifications, insurance claims history requests, loss run requests, and transcript requests from my educational institutions. SCI Anesthesia Services is also authorized to investigate my ability, employment records or character through inquires to individuals and/or employers mentioned in this application. I hereby agree that this authorization and appointment shall be valid until revoked by me in written revocation delivered to SCI Anesthesia Services. I hereby release SCI Anesthesia Services and the person(s) to whom the inquiry is made from any and all claims and liability growing out of such inquiries, and consent to the release of such information.