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Providing Home Care in Metro Atlanta and Surrounding Areas

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New employee onboarding

Complete each section carefully. All uploads and acknowledgments are required before your first shift. This link was shared only with you — please do not distribute it publicly.

New employee onboarding

All fields marked * are required. Your information is kept strictly confidential.

Full Legal Name *

Date of Birth *

Phone Number *Format: (000) 000-0000

Email *

Social Security # (XXX-XX-XXXX) *

Street Address *

Apartment, suite, etc

City *

State / Province *

ZIP / Postal code *

Country *

Emergency Contact – Name *

Emergency Contact – Phone Number *Format: (000) 000-0000

Driver License State & Number *example: GA/123456789

Upload Driver License or State Photo ID *

No file chosen

Upload Social Security Card or Passport (Employment Eligibility – I-9 Support) *

No file chosen

Certification Type *CNAPCAHHAOtherI have no certifications

License Number

Expiration Date (Certification/License)

Upload a copy of your Certification

No file chosen

Do you have a current Basic Life Support (BLS) or CPR Certification? *YesNo

Upload a copy of your BLS/CPR Certification *

No file chosen

Do you have a current GCHEXS determination? *YesNo

If Yes, Provide the Background Check # below

Are you physically able to perform caregiving duties? *YesNo

Able to lift/assist clients? *YesNo

Do you have a current Negative TB Test? *YesNo

Upload Negative TB Test *

No file chosen

Policy Acknowledgments *I understand that I must follow all care plans exactly.I understand that I must document all services each shift.I agree to maintain client confidentiality (HIPAA).I understand that I must report any incidences immediately.

Electronic Signature Acknowledgment

Electronic Signature Acknowledgment
By typing my full legal name below, I acknowledge that I have read and agree to the Elevare Home Care Employee Handbook and policies. I understand that this typed name serves as my legally binding electronic signature.

Date *

Type Full Legal Name (Electronic Signature) *By typing your name, you confirm this serves as your electronic signature

Please do not fill in this field.

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Contact Info

3500 Lenox Rd NE, Suite 1500, Atlanta, GA 30326
404.600.0090
678.616.0620
info@elevare-healthcare.com

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