We appreciate your interest in working at DCO.
In order to proceed with your evaluation, you will need to submit the following completed and signed documents in the form below.
DCO Provider Application
Complete and certify that all answers in the application are true and complete to the best of your knowledge. If this application leads to employment, understand that false or misleading information in the application or interview may result in my release.
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Disclaimer: Our Company does not discriminate in its process for conducting credentialing, preliminary background checks and in the submission of documentation to the assigned Health Plan.
Applicant Information Release
Authorize any person, educational institution, medical association, State Licensing Board or Company that have been listed in the DCO Provider Application form to disclose in good faith any information they may have regarding your qualifications, licensures and fitness for employment.
Non Criminal Record and Report Attestation
Acknowledge duty to inform DCO if charged with and/or convicted of a criminal offense at any time while I am part of the DCO Provider Network. Failure to do so will result in immediate termination of your contract with DCO. Attest that the statements are true and understand that falsification of this statement may lead to disciplinary action up to and including termination of your contract with DCO.
Download, read and fully understand the information on this form with your signature.