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Online Application

Community Healthcore
Human Resources
107 Woodbine Place
Longview, Texas  75601

For more information please contact Human Resources at (903) 237-2366.


Please complete the documents provided below and return to Community Healthcore. You can email your completed paperwork to peggy.bagley@communityhealthcore.com or fax it to (903) 753-7785.

Send with the forms:

A copy of your Degree from University
A copy of your License or License Number and Expiration Date
A copy of your Liability Insurance Coverage
If applicable, a Copy of your DEA and Controlled Substance Certificates or Numbers and expiration dates

You can also mail or drop your paperwork off at:

Community Healthcore
c/o Peggy Bagley
107 Woodbine Place
Longview, Texas 75601

Click here to download files:

  1. Independent Contract Information (Contract Manager reviews and fills out this form)
  2. Information Sheet for Credentialing (Contract Managers fill this out)
  3. Contractor Application (Contractor fills this out and all of the other forms)
  4. I-9 Form (This is filled out by an individual contractor)
  5. W-9 Form (This is filled out by a company only)
  6. Criminal History Check
  7. Confidentiality
  8. Attestation
  9. Business Code of Conduct
  10. Texas Credentialing Form (Physicians only fill this out)
  11. E-Verify Poster       Spanish version