Veteran Directed Care Worker
Apply today to be a provider for the Veteran Directed Care program!
Date of Application Completion
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email:
example@example.com
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
I acknowledge that I will be contacted periodically regarding my interest in becoming a Veteran Direct Care Worker.
*
Yes
Zip Code:
*
Please check all counties you are willing to work in.
*
Cuyahoga County
Geauga County
Lake County
Lorain County
Medina County
Are you willing to submit to a background check?
*
Yes
No
Best way to contact you?
Email
Phone
Morning
Afternoon
Please check all daily living assistance activities you are willing to provide:
*
Bathing
Dressing
Eating
Grooming
Transfering
Toileting
Transportation with your vehicle
Transportation with their vehicle
Household cleaning
Yardwork
Laundry
Meal prep
Shopping
How many hours are you available per week?
*
0-10 hours
10-20 hours
20-30 hours
30-40 hours
Submit
Should be Empty: