RN Certification Bonus Application (2025)

RN Certification Bonus Application Form
Welcome to the RN Certification Application Form!

To apply, please review the RN Certification Bonus Program document below, which outlines key eligibility criteria and includes a list of approved departments, certifications, and credentialling centers. Then, complete and submit the form on the following page to complete your application.

If the job title, department, certification, or credentialing center is not listed the employee is unable to apply for this bonus. To request an appeal, please submit an AskHR ticket with the topic being "RN Certification Appeal"

Please complete the RN Certification Application Form with accurate information, then select “Submit.” Once submitted, a copy of your form will be sent to your work email.
Name*

First NameLast Name
Employee ID Number*
Your Salem Health Email Address*
example@example.com
Work Location*
Job Title*
Department Name*
Certificates for A4E*
Certificates for SH Ambulatory Anti-Coagulation*
Certificates for SH Bariatric Services*
Certificates for SH Cardiac Non-Invasive Services & SH Angiography*
Certificates for SH CVCU*
Certificates for SH Diabetes Education*
Certificates for SH Emergency Department & WVH Emergency Department*
Certificates for SH Endoscopy Lab*
Certificates for SH GYN Oncology*
Certificates for SH ICU Intensive Care Unit*
Certificates for SH Imaging Administration*
Certificates for SH IMCU Intermediate Care Unit*
Certificates for SH Infusion & Wound Care*
Certificates for SH Interventional Recovery Unit*
Certificates for SH IP Rehab Nursing*
Certificates for SH Labor & Delivery*
Certificates for Medical-Surgical Units *
Certificates for SH Mother-Baby Unit and SH Lactation*
Certificates for SH NICU*
Certificates for SH NTCU*
Certificates for SH Operating Room*
Certificates for SH Pediatrics and SH Women's & Children's Float Pool*
Certificates for SH Prep Recovery, SH Pre-Surgical Screening, & SH PACU*
(PACU Department: only recognized for the bonus until RN has met the eligibility requirements for the CPAN Certification)
Certificates for SH Psychiatric Patient Services*
Certificates for SH Radiation Oncology*
Certificates for SH Trauma Services*
Certificates for SH Vascular Access*
Certificates for SHMG Maternal-Fetal Medicine Clinic*
Certificates for SHMG OBGYN Clinic*
Certificates for SHMG Prenatal Clinic*
Certificates for SH Wound & Ostomy Nursing & WVH Infusion & Wound Care*
Certificates for WVH Medical Services*
Certificates for WVH Surgical Services*
Certificates for SH Building S OR/SPD and SH Building S PreOp & PostOp*
Approved Credentialing Centers for A4E*
Approved Credentialing Centers for SH Ambulatory Anti-Coagulation*
Approved Credentialing Centers for SH Bariatric Services*
Approved Credentialing Centers for SH Cardiac Non-Invasive Services &SH Angiography*
Approved Credentialing Centers for SH CVCU*
Approved Credentialing Centers for SH Diabetes Education*
Approved Credentialing Centers for SH Emergency Department & WVH Emergency Department*
Approved Credentialing Centers for SH Endoscopy Lab*
Approved Credentialing Centers for SH GYN Oncology*
Approved Credentialing Centers for SH ICU Intensive Care Unit*
Approved Credentialing Centers for SH Imaging Administration*
Approved Credentialing Centers for SH IMCU Intermediate Care Unit*
Approved Credentialing Centers for SH Infusion & Wound Care*
Approved Credentialing Centers for SH Interventional Recovery Unit*
Approved Credentialing Centers for SH IP Rehab Nursing*
Approved Credentialing Centers for SH Labor & Delivery*
Approved Credentialing Centers for SH Medical-Surgical Units*
Approved Credentialing Centers for SH Mother-Baby Unit and SH Lactation*
Approved Credentialing Centers for SH NICU*
Approved Credentialing Centers for SH NTCU*
Approved Credentialing Centers for SH Operating Room*
Approved Credentialing Centers for SH Pediatrics and SH Women's & Children's Flt Pool*
Approved Credentialing Centers for SH Prep Recovery, SH Pre-Surgical Screening, & SH PACU*
Approved Credentialing Centers for SH Psychiatric Patient Services*
Approved Credentialing Centers for SH Radiation Oncology*
Approved Credentialing Centers for SH Trauma Services*
Approved Credentialing Centers for SH Vascular Access*
Approved Credentialing Centers for SHMG Maternal-Fetal Medicine Clinic*
Approved Credentialing Centers for SHMG OBGYN Clinic*
Approved Credentialing Centers for SHMG Prenatal Clinic*
Approved Credentialing Centers for SH Wound & Ostomy Nursing & WVH Infusion & Wound Care*
Approved Credentialing Centers for WVH Medical Services*
Approved Credentialing Centers for WVH Surgical Services*
Approved Credentialing Centers for SH Building S OR/SPD andSH Building S PreOp & PostOp*
Certification Issue Date*

MonthDayYear
Date
Unfortunately, based on your selection, you are not eligible to apply for the RN Certification Bonus.

If you believe you made an error, please correct and then submit your application.

If your selection was not an error and you would like to request a job, department, certification, or credentialing center to be added, please submit an AskHR ticket using the topic 'RN Certification Appeal' for it to be reviewed.
Is this a new certificate or certificate renewal ?*

New certificateCertificate renewal
Certification Expiration Date*

MonthDayYear
Date
Upload supporting documentation confirming your valid certificate (new/renewal). *

Browse Files
Please ensure that your documentation includes the issue and expiration dates, and Employee's name is written as Salem Health has it documented (multiple documents can be uploaded). Cancelof
Please confirm that your application includes:*

Certification Issue Date/Anniversary of Issue Date is visible on the attachmentCertification Expiration Date is visible on the attachment and is not set to expire for at least another 6 monthsEmployee's name is visible on the attachment as Salem Health has it documentedMeets all eligibility requirements required for the RN Certification Bonus
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
By submitting this application, you confirm that you meet all eligibility requirements, have provided all necessary documentation, and are applying for certification through an approved credentialing center within the department in which you are employed. Failure to comply with any of these requirements may result in the denial of your application.

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*

MonthDayYear
Date
Approving HR Rep Email Address*
example@salemhealth.org

Human Resources 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.
Date*

MonthDayYear
Date
Should be Empty:

RN Certification Bonus Application Form

Adding your Certification to Infor

Employee Signature

Manager Review

Human Resources Review