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Caregiver (HHA/PCA) Application

Documents that are necessary for completing the application process:

  • UNEXPIRED – NYS ID, Drivers License, Passport, Permanent Resident Card and/or Work Authorization Card
  • Valid I9 documentation
  • HHA/PCA Certificate – (Originals Only)
  • Two (2) Reference Letters – Professional work letter (ex: from a Pastor, Priest, Doctor, Lawyer, Nurse, Teacher, Professor, Business Owner, or if you have worked a Private Case then a letter from the Patient or one of their family members. If you have never worked you still need a letter from a Pastor, Priest, Doctor, Lawyer, Nurse, Teacher, Professor or Business Owner.
  • Physical – (Not more 3 than months old)
  • Drug Screen – (Not more than 3 months old) (Lab Report with results)
  • Rubella Immunization – must be POSITIVE with Titers on LAB Report. (This Never expires)
  • Rubeola/Measles Immunization – must be POSITIVE with Titers on LAB Report. (This Never expires)
  • PPD, if positive (must have proof of positive PPD) and Chest X-Ray
    • ** If PPD is NEGATIVE you MUST have result information on Physical form
    • ** If PPD is POSITIVE you MUST have CHEST X-RAY Lab Report
    • ** Chest X-Ray can NOT be Older than 5 years