Gees Home Caring Agency, LLC
New Hire Checklist
Name
First Name
Last Name
Address
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SS#
Phone
Cell
Email
Document Proof
Rows
IN FILE
NEED DOCUMENTS
Resume
References
Copy of Social Security
Direct Deposit Form
CPR / First Aid
TB Testing
Background Check Consent
Driving License or other State ID
Licensing (RN, CNA, PCA etc.)
Client's Rights and Responsibilities
Privacy Notice / Pledge of Confidentiality
Reporting Abuse / Abuse Neglect Assertation
Staff Signature
Title
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: