North Carolina Division of State Operated Healthcare Facilities (DSOHF)
**The forms in this section are required for all NC DHHS DSOHF Facilities**
North Carolina Department of Revenue
| Click link on right for Adobe Sign or PDF | ||
| NC-4 EZ Employee’s Withholding Allowance Certificate (Short Form) | Adobe Sign | |
| NC-4 Employee’s Withholding Allowance Certificate (Long Form) | Adobe Sign |
North Carolina Department of Public Safety (Corrections)
| Click link on right for Adobe Sign or PDF | ||
| Candidate Nursing Requirements (PDF Only) | ||
| DPS Criminal History Record Check | Adobe Sign |
Broughton Hospital – Morganton, NC
Nurses will be tested on the following document:
| Medication Administration Education Program (PDF Only) |
Caswell Developmental Center – Kinston, NC
| Click link on right for Adobe Sign or PDF | ||
| Required Documents | Adobe Sign | |
| Employee Information Sheet | Adobe Sign |
Central Regional Hospital – Butner, NC
Documents to Review:
| Compliance Checklist (PDF Only) | ||
| Memo Regarding Levels of Observation (PDF Only) |
Nurses will be tested on the following documents:
| Medication Administration Education Program Study Guide (PDF Only) | ||
| Fast Track Testing Materials for Nurses (PDF Only) |
CNAs will be tested on the following documents:
| Fast Track Testing Materials for CNAs (PDF Only) |
Cherry Hospital – Goldsboro, NC
Nurses will be tested on the following two documents:
| Basic Concepts in Psychiatric Nursing (PDF Only) | ||
| Medication Administration Education Program Study Guide (PDF Only) |
Longleaf Neuro-Medical Treatment Center
| Click link on right for Adobe Sign or PDF | ||
| LPN Job Description | Adobe Sign | |
| HCT Job Description | Adobe Sign |
Murdoch Developmental Center
| Click link on right for Adobe Sign or PDF | ||
| DHHS Criminal Record Check Consent Form and Release of Information | Adobe Sign |