1ST CHOICE SENIOR HOMECARE, INC



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APPLICATION REQUIREMENTS

*Every Applicant MUST submit the following and finish Item no. 11.

Submitted Missing

1. Filled up Application _________ _________

2. Driver License and/or State ID _________ _________

3. Social Security Card _________ _________

4. Working Permit _________ _________

5. Green Card/US Passport _________ _________

6. Latest Medical Certificate _________ _________

7. Latest Physical _________ _________

8. T.B. Test _________ _________

9. C.N.A. Certificate _________ _________

10. Training Certificates _________ _________

11. Competency Assessment _________ _________

12. IDPH BC Fingerprint Form _________ _________

Checked by: Name of Caregiver:

_____________________ ________________________

1st Choice Representative

Note: Every Application Packet must have the ff:

1. Application Form

2. I-9 form

3. Healthcare Background Check form

4. Personality Assessment Form

5. Physical Test Form

6. IDPH form for fingerprinting

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