Get Caregiving Experience Attestation

The Caregiving Experience Attestation (CEA) form is essential for applicants seeking licensure for adult family homes. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently, ensuring compliance with Washington state regulations.

Follow the steps to fill out the Caregiving Experience Attestation correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Identify your role by checking the appropriate box in Section 1: Individual applicant, spouse co-provider, entity representative, or resident manager. This establishes your identity as the applicant.
3. Provide your full name, the name of the proposed adult family home, the county where it will be located, and the physical address including city, state, and zip code.
4. In Section 2, the attestor must fill out their information. They need to provide their name, two contact telephone numbers, the best time to call, and their relationship to the individual named in Section 1.
5. The attestor should detail their professional relationship with the applicant by selecting one of the options provided and mentioning any relevant care settings where they worked together.
6. Include specific information about the direct caregiving experience: confirm if the attestor personally observed the individual providing care to vulnerable adults, and detail the total hours of caregiving experience.
7. Rate the applicant on their ability to meet the physical and emotional needs of care recipients, reliability, and ability to follow procedures. Provide descriptions of their skills and any areas needing improvement.
8. Complete the form by signing it and ensuring that a notary public is present to notarize the attestation. Their signature and the date are also required for the form to be valid.
9. Finally, save your changes. Users can then download and print the completed form or share it as necessary.

Complete your Caregiving Experience Attestation online today to ensure a smooth application process for adult family home licensure.