If you need to cancel or change your sign up slot, email
Do NOT forget to close your browser after signing up!
Please complete this form to sign up to work at a Centra COVID-19 vaccine clinic. Please exit the form if you have reached it in error.
Projected last day for vaccine clinic to be open is Friday 2/26/2021, closing at 5 PM
COVID-19 Vaccine Clinic Staffing Form
Name (and Title):
Can you administer medication?
Can you document medication in Centra’s Cerner EMR?
Select one of the following:
I am clinical
I am non-clinical
Time Selection Section
Each time you select a role above, click the button to update the time slots!!
Select Role, then click button to find available time slots ===>
No Time Slots Available