Dayle McIntosh Center - Care Provider Registry Application

Do you have reliable mobility? *

Initial Screening Questions

Have you worked as a caregiver before? *
Are you currently enrolled as an IHSS care provider? *
Are you open to becoming an IHSS care provider? *
(The hourly rate for IHSS is $16.75; Overtime is $25.12 "over 40 hours a week")
Are you willing to complete a live scan background check? *
Have you had a Covid-19 vaccine? *
Are you willing to get the vaccine? *


Are you a smoker? *
Willing to work in a smoking environment? *
Willing to work around pets?
If yes, what type of pet:
Will work with: *
Availability: *
Languages: *
Available Days / Times: Morning (until 12 noon); Afternoon (until 5PM); Evening (after 5PM)
Tasks: *
Devices: *


North & West Orange County:
Central & South Orange County


Personal Home Care Worker: *
First Aid/ CPR (Recommended): *
Certified Nursing Assistant (CNA): *
Certified Home Health Agency (CHHA): *
Licensed Practical or Vocational Nurse (LVN/PN): *

Please provide a non-family member reference.

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