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Does your phone accept texts?
Yes
No
Are you taking new clients?
Yes — accepting
Not accepting
Training — check all that apply. HCA = Home Care Aide, CNA = Certified Nursing Assistant. Other medical profession = RN, LPN, PT, OT, MD or other licensed medical professional.
Home care certification or other medical license
Current active certification or license
Previous certification or license
Never certified or licensed
Are you registered with CDWA as a caregiver for COPES clients?
Yes
No
I don't know if I am registered
Services you provide — check all that apply. Companion care = keeping clients safe and entertained. Personal care = bathing, dressing, feeding, toileting, transfers. Household = meal prep, shopping and errands, laundry, light housework.
Working hours — check all that apply
Preferences — check all that apply
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