Join the PDQLY Provider Network Independent Contractor Registration
“We appreciate your interest in joining PDQ Home Care Provider Network. All registrants are reviewed based on current service demand in your area. If selected to onboard, you will receive a confidential email with onboarding instructions.”
Full Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City / ZIP Code
*
Which General Care Tasks - (No Client Contact) can you perform? (Select all that apply)
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Dog walking
Light housekeeping
Patient-area housekeeping
Dish washing
Grocery shopping
Prescription pick-up
Companionship
Laundry
Which Personal Care Tasks can you perform? (Select all that apply)
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Organizing
Sterilized housekeeping
Soiled Laundry
Institutional bed-making
Meal-Prep / Cooking
Transportation assistance
Incontinence care
Physical fitness support
Do you currently hold any of the following certifications? (Select all that apply)
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CNA
Home Health Aide
Caregiver Training Certificate
Medical Assistant
Other
None
Are you available for short-notice requests?
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Yes
No
Do you have reliable transportation?
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Yes
No
Do you have a current driver's license and insurance?
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Yes
No
What date can you begin gigging? Preferred days/times (optional)
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Select Your Preferred Area within 10 miles of your zip code
*
Please Select
Chino
Claremont
Covina
Diamond Bar
Glendora
Industry
La Verne
Montclair
Ontario
Pomona
San Dimas
Upland
Walnut
West Covina
Walnut
Are you legally authorized to work as an independent contractor?
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Yes
No
Are you an In Home Support Service (IHSS) Provider? (IHSS providers may be eligible for expedited onboarding. All applicants are still subject to a background screening.)
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Yes
No
Do you have an active In Home Support Service (IHSS) Provider number?
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Yes
No
In the past 12 months have you completed a background check using live-scan?
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Yes
No
Have you ever had an unfavorable background result from check using live-scan?
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Yes
No
If selected to onboard are you willing to complete a Checkr (gig-work) background and drug test?
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Yes
No
Do you understand this is gig-based, task-based work (not employment)?
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Yes
No
How did you hear about PDQLY?
*
School/Training Program
Social Media
Craigslist
Google
Recruiter
Friend
Submit Registration
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