• Home Health Aide Independent Contractor Registration

    Please complete the form below to register as an Independent Contractor with us.
  • BEFORE YOU START: Please be aware that we require all documents to be uploaded here in the registration. If you do not have digital copies of your documents, you may take CLEAR photos of the original documents and upload the photos. ***ALL fields of the document must be clear or your registration may not be processed.

  •  -
  •  -  -
    Pick a Date
  • DOCUMENT UPLOAD: Color uploads required (NOT photo copies). You may upload a CLEAR photo of the document with your phone; ALL areas / fields of document MUST be clear. Pursuant to Florida state law, we cannot process a registration without the below documents.

  • Upload a File
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • Browse Files
    Cancel of
  • WORK HISTORY:

    Please list below 3 previous employers:
  • Work History #1

  •  -
  •  -  -
    Pick a Date
  •  -  -
    Pick a Date
  • Work History #2

  •  -
  •  -  -
    Pick a Date
  •  -  -
    Pick a Date
  • Work History #3

  •  -
  •  -  -
    Pick a Date
  •  -  -
    Pick a Date
  • EDUCATIONAL HISTORY:

  • Educational History #1

  • Educational History #2

  • EMERGENCY CONTACT:

    Please list your emergency contact person's information:
  • Caregiver Availability

    Please fill in the following sections:
  • Live-In Aide Responsibility:

    A Live-In Aide is entitled to a minimum of 8 hours of uninterrupted sleep per night. It is your responsibility to advise CareGivers of America to report sleep time interruptions.
  • AREAS IN WHICH YOU ARE AVAILABLE

    Please click on all that apply:
  • FDLE: Please be advised that CareGivers of America runs a background screening through the Florida Department of Law Enforcement.

  • SIGNATURE: By e-signing below, you are solemnly swearing that you have never been arrested or convicted of any offense.

  • Clear
  • Please note the following important information below:

  • Authorization and Consent: I grant authorization and consent to CareGivers of America to conduct a criminal background check, conviction records check, abuse registry check, previous employment reference check and driving record check for the purpose of my Independent Contractor Agreement with CareGivers of America and its affiliated corporations/agencies.

  • Release of Liability regarding background checks: I authorize the disclosure of employment information and I release CareGivers of America and the provider of such information from any and all liability for damages arising from the investigation and disclosure of the requested information. I allow a photocopy/fax/email copy of this authorization to be as valid as the original.

  • *Signature: I have read the above sections of Authorization and Consent and Release of Liability and sign below that I understand and authorize:

  • Clear
  • Completion of Registration: I certify by signing below that the information provided here is accurate and true.

  • Clear
  • CareGivers of America

    4450 N University Dr, Lauderhill, FL 33319

    Broward: 954-722-7662  Miami-Dade: 305-654-7414 Palm Beach: 561-832-0504

  • Should be Empty: