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Our agency works under the Agency for Persons with Disabilities (APD) and the Agency for Health Care Administration (AHCA) Medicaid. Therefore, all our independent contractor providers must have all the documentation and certifications that both APD and AHCA Medicaid require.

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High School Diploma
HHA & CNA Certifications
Professional License (if applicable)
Certificate Professional Liability Insurance
Driver License
Social Security Card
Background Screening Level II
Local Law Background Police Check
Professional Experience Verification
Attestation of Good Moral Character

Required Certifications

CPR & First Aid
Zero Tolerance
Driver License
Social Security Card

The following must be completed/submitted prior to signing a contract to begin providing services

Employment Application

SECTION 1 - General Contact Info

Do you have a Level II background check
Are you eligible to work in the US?
Are you a legal US citizen?

SECTION 2 - Position & Availability

Available for emergencies
available for a 24-hour live-in position?

SECTION 3 - Education

SECTION 4 - Experience (Caregivers only)

SECTION 5 - Employment History

May we contact your current employer

SECTION 6 - References (Do Not Include Relatives):

SECTION 7 - Criminal History:

Have you ever been confined of a felony or misdemeanor?

SECTION 8 - Emergency Contact Information

If you need help filling out this application form or for any step of the employment process, please notify the person who gave you this form. Please read the Applicant Note, Certification & Release and Restrictive Covenant at the bottom of the application before signing.

Evan Home Care is an equal opportunity employer, dedicated to a policy of non-discrimination on any basis including color, race, ethnicity, national origin, religion, sex, gender, sexual orientation, disability, age, or marital status. All information on this application is confidential.

Certification & Release:

I certify that the above stated and indicated are true in fact and no misrepresentation of myself has been made. I understand that any false information, omissions, or misrepresentations of facts will result in rejection of this application and/or discharge at any time during employment.

I authorize Evan Home Care to verify all information contained within this application and the Clearinghouse Background Screening Level II check. I authorize all persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the illegal use of drugs is prohibited during employment and that I am willing to submit to drug testing at any time to detect the use of illegal drugs prior to or during employment with Evan Home Care.

Restrictive Covenant

I agree to not do business directly with any individual or business that Evan Home Care has introduced to me or by entering employment with such individuals or businesses.

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