• CDS Personal Care Attendant Employment Application

  • Personal Care Attendants must meet the following qualifications: be at least eighteen (18) years of age; be able to meet the physical and mental demands required to perform specific tasks required by a particular consumer; agree to maintain confidentiality; be emotionally mature and dependable; be able to handle emergency type situations; and not be the consumer's spouse or legal guardian.

  • Please be sure to complete the Missouri Department of Health and Senior Services Family Care Safety Registry Worker Registration Form.

  • Clear
  •  -  -
    Pick a Date
  • Attendant

  • Attendants must meet the following qualifications:

    A. Be at least eight (18) years of age;
    B. Be able to meet the physical and mental demands required to perform specific tasks required by a particular consumer;
    C. Agree to maintain confidentiality;
    D. Be emotionally mature and dependable;
    E. Be able to handle emergency type situations; and
    F. Not be the consumer's spouse or legal guardian.

    Registered, screened, and employable pusuant to the Family Care Safety Registry (FCSR).
    Office Staff Confirmed ____

    Registered, screened, and employable pursuant to Employee Disqualification List (EDL).
    Office Staff Confirmed ____

    Screened and employable pursuant to the Office of Inspector General (OIG).
    Office Staff Confirmed ____

    Eligible to work in the United States through E-Verify screening.
    Office Staff Confirmed ____

     

    ABUSE, NEGLECT, AND EXPLOITATION REPORTING

    All attendants are mandated reports by law to report suspicions and/or allegations of abuse, neglect, and/or exploitation. If you suspect someone is being abused, neglected, or exploited, call the hotline at 800-392-0210.

    Abuse - the infliction of physical, sexual, or emotional injury or harm including financial exploitation by any person, firm, or corporation.

    Neglect - the failure to provide services to an eligible adult by any person, firm or corporation with a legal or contractual duty to do so, when such failure presents either an imminent danger to the health, safety, or welfare of the client or substantial probability that death or serious physical harm would result.

    Financial Exploitation - a person knowingly by deception, intimidation, undue influence, or force obtains control over the elderly or disable dperson's property.

  • Clear
  •  -  -
    Pick a Date
  • Attendant understands and agrees he/she is an employee of the consumer only for the time period subsidized with CDS funds, but is never the employee of Premier Home Health Care, Inc., DHSS, or the state of Missouri.

  • Clear
  •  -  -
    Pick a Date
  • Should be Empty: