Get Caregiving Experience Attestation Cea Form - Dshs Wa

The Caregiving Experience Attestation CEA Form is a crucial document required for applicants seeking licensure in Washington state’s adult family home system. This guide offers clear, step-by-step instructions to help users complete the form effectively online.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to obtain the Caregiving Experience Attestation CEA Form and open it in the editor.
2. In Section 1, provide your name and role as either the individual applicant, spouse co-provider, entity representative, or resident manager. Enter the proposed adult family home's name, county, and full address.
3. In Section 2, complete information required by the attestor. Start by providing your name and title or role, and two contact telephone numbers where you can be reached.
4. Indicate your relationship to the individual named in Section 1, selecting from the options provided (e.g., co-worker, employer, client).
5. Affirm whether the individual currently works for you and specify the care setting where you worked with them.
6. Confirm whether you personally observed the individual providing care to a vulnerable adult and if their primary responsibilities included direct care.
7. Check if the individual’s total direct care experience exceeds 1,000 hours, including the dates the care was provided and if it falls within the past 60 months.
8. Rate the applicant's abilities in various areas, including meeting the needs of care recipients and reliability. Provide descriptions where necessary.
9. Indicate whether you would employ this person as a caregiver for vulnerable adults and provide a signature. Ensure the form is notarized.

Complete your documents online to ensure a smooth application process.