This form is a sample of an agreement between an elderly or disabled client and a Caregiver who operates as an independent contractor and provides personnel to assist Client to live at home and to have as much control over the home environment and life as possible under the circumstances. Caregiver's personnel also assist Client with the activities of daily living, scheduling medication, assistance with mobility, accompanying Client on errands and appointments, and such other services as agreed between Client and Caregiver.
In this agreement, Client waives damages for simple negligence of Caregiver, but not gross negligence or misconduct that is intentional or criminal in nature. Courts generally will not enforce waivers of this type of misconduct since such a waiver would be deemed to be against public policy because it would encourage dangerous and illegal behavior.
Application Form For Caregiver In Alameda
Category:
State:
Multi-State
County:
Alameda
Control #:
US-00458BG
Format:
Word;
Rich Text
Instant download
Description
Free preview
Form popularity
FAQ
To be eligible for IHSS, an individual must be Medi-Cal eligible or must be receiving Supplemental Security Income (SSI) benefits. The IHSS program provides payment for non-medical in-home care for qualified individuals who are unable to remain safely in their homes without this assistance.
MY PHONE: Call 510-577-1800 weekdays from AM - 12 Noon or - PM. Once you dial, when prompted, press “1” for English and then “1” for applying for IHSS and “1” a third time to speak with an intake screener. 2. BY MAIL: Request an application to be mailed to client's home.
If you would like to apply over the phone, call us at (510) 272-3663. If you need an application packet to be mailed to you, call us at (510) 272-3663 or 1-888-999-4772.
General Assistance/Relief Most people can get GA payments for 3 months out of a 12 month period. People who cannot work due to a disability ("unemployable") can continue to get GA benefits longer than 3 months.
To be eligible for GA, you must: Be a county resident. Be age 18 or older, or. An emancipated minor, or. A child under age 18 who has no means of support. (There are special rules for children. Be low-income. Be a citizen or have legal immigration status. Follow the county rules.
To apply by phone, or to request a CalFresh Mail-In application to be mailed to you, please call (510) 272-3663. To apply for CalFresh by mail, you may send mail your CalFreshapplication to P.O. Box 12941, Oakland, CA 94604. You may click here for a printable CalFresh application (CF 285).
Under the law, you are ineligible to work in the IHSS program ONLY if you have been convicted within the last 10 years of: 1) fraud against a government health care or supportive services program; 2) child abuse; or 3) abuse of an elder or dependent adult.
To become a caregiver in California, meet state requirements (work authorization, background check, good health), complete a Home Care Aide certification course and provide proof of vaccinations and a negative TB test.
Eligibility. To become an IHSS Provider, you must: Complete and sign all mandatory forms included in the IHSS Program Provider Enrollment Packet and return it to the County IHSS Office. Be fingerprinted and go through a criminal background check by the California Department of Justice (DOJ).
Submit a completed and signed Application for In-Home Supportive Services SOC 295 to: IHSSSOC295Apps@acgov.