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This form has been disabled.
If you are looking to apply for your RN Certification Bonus, please visit the new RN Certification form by clicking here
Please review the RN Certification Bonus Program criteria below before completing this form.
Name*

First NameLast Name
Employee #*
Employee Number*
Your Salem Health Email Address*
example@example.com
Job Title*
Department Name*
Certificate Achieved*
Certification Issue Date*

MonthDayYear
Date
Certification Expiration Date*

MonthDayYear
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).*

Browse Files

Cancelof
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 DateCertification 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*

Clear
Date*

MonthDayYear
Date
Approving Manager's Salem Health Email Address*
example@salemhealth.org

Adding your Certification to Infor