Docusign

Thank you for joining CaregiverNC! Please see below for important information you will need to provide before beginning Step 3 of the CaregiverNC accreditation process – DocuSign.

Please note: If you begin filling out your DocuSign paperwork and are unable to complete it, please be sure to click “Finish Later” at the top right hand side of the page, enter your email address and click “Save & Close” to save the documents in their current state. You will be emailed a link to access your documents and finish the signing process at a later time.

Agreement:

Please review, and electronically sign this document. Please note: The third line of the agreement states “WHEREAS, Care Provider is a self-employed ______________ (highest license/certification or skill level);” In this space the Care Provider should provide ONLY the highest license, certification, or skill level that they currently hold. Example: CNA, LPN, RN, or companion.

Employment Validation Form:

You will need to provide information regarding your past five years of employment on this form. This will include:

  • Company names and phone numbers
  • Dates of employment, job title, and reason for leaving (please note: if there are any gaps in your employment history during the past five years, please provide dates along with an explanation of why you were unemployed during that time period. Example: In school, stay at home parent, seeking employment, illness, etc. In addition, the name of someone who can verify this information along with a contact number should be provided.)

Care Provider Reference Form:

Please provide two professional references. Example: Supervisor, co-worker, or someone you have worked with in a professional setting. This may also include private duty clients. Personal references are not accepted.

  • Reference names and phone numbers will need to be provided

Independent Contractor Representations:

Please review, initial, and electronically sign this document.

Form I-9:

Please provide your personal information on this form and sign it electronically. This will include:

  • Full name
  • Address
  • Date of Birth
  • Social Security Number
  • Email Address
  • Telephone number

Please note: You will also need to provide a copy of your valid NC Identification or driver’s license as well as a copy of your social security card. Copies may be emailed to info@caregivernc.com or faxed to (910) 692-4436.

W-9:

Please provide your personal information on this form and sign it electronically. This will include:

  • Full Name
  • Address
  • EIN # (obtained during Step 1 of the registration process – “Apply for an EIN Number”)

Disclosure:

Please provide your personal information on this form and sign it electronically. This will include:

  • Full Name
  • Address

Authorization:

Please provide your personal information on this form and sign it electronically. This will include:

  • Full Name
  • Address

Employment Screening Services Authorization for Background Report:

Please provide your personal information on this form and sign it electronically. This will include:

  • Full Name
  • Date of Birth
  • Social Security Number
  • Driver License Number
  • State your Driver License was issued in
  • Address
  • Alias Names

When you have finished entering your information and signing the forms, please be sure to click “Finish” at the bottom or top of the page to submit your documents.

 

Click here to fill out your forms on Docusign.

Docusign Landing Page was last modified: June 25th, 2019 by