Certificate of Applicant/Permission to release information
I certify that all the information provided in this application is true. I understand that any false information may eliminate me from enrollment in the Homecare Provider Registry.
I understand that my name and phone number(s) may be placed on a list to be given to persons who are seeking assistance in their homes.
I understand that the information on this questionnaire may also be shared with prospective employers without any further notice.
I understand completing this application and getting placed on the Registry does not guarantee me employment.
I further understand that my employer is not San Joaquin In-Home Supportive Services (IHSS) or the San Joaquin County IHSS Public Authority. The IHSS client is my employer. The San Joaquin County IHSS Public Authority is strictly an "employer of record" for purposes of collective bargaining. I understand that no oral or written agreement may supersede or alter this relationship.