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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