Patient Care Technician (PCT) / Patient Care Associate (PCA) Employer Verification

Aug 31, 2026

Upload by Aditya

This document is a Patient Care Technician (PCT) / Patient Care Associate (PCA) Employer Verification form. It is designed to be completed by an employer to verify that a candidate has been employed in one of these roles for at least 12 months. The form requires detailed information about the candidate, including their name, student ID, and email. It also requires comprehensive information about the employer, such as the facility name, address, phone number, and supervisor's contact details. The core of the verification lies in confirming the position title (PCT or PCA), employment start and end dates, and the total length of employment, ensuring it meets the minimum 12-month requirement. The form includes a checklist for common job responsibilities such as obtaining vital signs, performing blood glucose monitoring, assisting with activities of daily living, reporting abnormal findings, and documentation in medical records. Employers are also prompted to attach an official job description if available. The employer must provide a formal attestation, certifying the accuracy of the information and the fulfillment of employment requirements, followed by a supervisor's signature and date. Finally, submission instructions are provided, directing the completed form to be submitted with the candidate's application to the Practical Nursing Program at their Chester Campus, with the full address provided.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Candidate Information

Employer Information

Employment Verification

Job Responsibilities

Employer Attestation

Submission Instructions

FAQs

What is the purpose of this Employer Verification form?

This form is used by employers to verify that a candidate has been employed as a Patient Care Technician (PCT) or Patient Care Associate (PCA) for at least 12 months, as a requirement for application to the Practical Nursing Program.

What information is required from the candidate and employer?

The form requires the candidate's name, Student ID, and email, along with the employer's facility name, address, phone number, and supervisor's details.

What are some of the job responsibilities that can be checked on this form?

The job responsibilities listed include obtaining and documenting vital signs, performing blood glucose monitoring, assisting with activities of daily living, reporting abnormal findings, and documentation in medical records.

Aug 31, 2026

Upload by Aditya