Full Time Staff RNs and Shift Supervisor RNs requesting Loan Repayment or the Bonus Offer must complete and submit the following:



First Name: *
Middle Name:
Last Name: *
Email address:
Confirm email address:
Department: *
Job Title: * Full-Time Staff RN

Shift Supervisor RN
Address *
PMC Phone/Extension: *
Home/Mobile Phone: *


* I understand that this agreement will reduce my base hourly pay by $2 per hour. Once the agreement is completed my pay will be reinstated. By checking this box, I further agree that I have not yet entered into any kind of bonus/student loan repayment or similar agreement with Pikeville Medical Center which might disqualify me.

* = required

For the employees that are choosing the loan repayment, please email one or more good quality photos/screenshots of all pertinent loan details from each lender to or

Any questions concerning this call Joe or Mike at 3504.

Pikeville Medical Center