RN Certification Bonus Application
Please review the RN Certification Bonus Program criteria below before completing this form.
Name
*
First Name
Last Name
Employee #
*
Employee Number
*
Your Salem Health Email Address
*
example@example.com
Job Title
*
2647- Assistant Nurse Manager
3215- Ostomy & Wound Nurse
3251- RN New Grad
3252- RN Staff Nurse
3254- RN BSN Staff Nurse
3672- RN First Assistant
Department Name
*
Certificate Achieved
*
Certification Issue Date
*
-
Month
-
Day
Year
Date
Certification Expiration Date
*
-
Month
-
Day
Year
Date
Upload supporting documentation confirming receipt of your certification. Please ensure that your documentation includes the issue and expiration dates (multiple documents can be uploaded).
*
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Please confirm that your documentation includes (If upon review, your documentation is missing the below, your submission will be denied):
*
Certification Issue Date/Anniversary of Issue Date
Certification Expiration Date
Adding your Certification to Infor
To receive your certification bonus, you are required to enter your certification information into Infor.
To complete this process, first click the link below:
MyHR/Infor
Step 2:
Step 3:
Step 4:
Employee Signature
I confirm that I have read the RN Certification Bonus Program criteria and meet the stated requirements.
Employee Signature
*
Date
*
-
Month
-
Day
Year
Date
Approving Manager's Salem Health Email Address
*
example@salemhealth.org
Submit
Back
Next
Manager Review
I confirm that the certification is relevant to improving quality of care in this RN’s role. This RN is regularly scheduled in the above department and has successfully completed his or her introductory period with Salem Health. Additionally, the employee has not received a written reminder or final written warning in the last six months, or remaining problems from a written reminder or final written warning in the last year.
Manager Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Print For Your Records
Should be Empty:
