ShiftCare — Home Care Agency
Caregiver Employment Intake & Consent Form
Form SC-100  ·  Rev. June 2026
Section 1 — Personal Information
Section 2 — Employment & Certifications
CNA HHA PCA RN LPN Other:
Mon Tue Wed Thu Fri Sat Sun
Section 3 — SMS / Text Message Consent (Required)
Section 4 — Signature & Acknowledgment

By signing below, I confirm that all information provided on this form is accurate and complete. I have read and understand the SMS consent terms above. I acknowledge receipt of the ShiftCare Employee Handbook (if provided).