Direct Care Worker
Request for Information

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Soreo® In Home Support Services, LLC is an administrator of in-home support services whose business is to obtain and/or administer contracts for in-home services for clients who are eligible for Arizona’s Long Term Care System or for eligible services through other public and private entities by subcontracting with professional independent caregivers.

Soreo® In Home Support Services, LLC is seeking to hire qualified Direct Care Workers who are professional independent caregivers in the business of providing in-home support services.

The material requested in this document is to provide Soreo® In Home Support Services, LLC with information to determine if your qualifications match Soreo® In Home Support Services, LLC’s current needs. Please respond fully to each question.

Personal Information


Have you ever interviewed with Soreo or its affiliates before?
Have you ever been employed by Soreo or its affiliates before?
Do you have any relatives employed by Soreo or its affiliates?

DCW Qualifications

There are certain requirements that must be met to provide Direct Care Worker services to Soreo clients. Do you have the following (a "No" answer may not preclude you from obtaining a contract as you will have the opportunity to be compliant with these requirements):

Do you have DCW training certification?
Do you have experience using a Hoyer lift?
Do you have experience using a gait belt?
Do you have experience cooking?
Do you have experience ironing?
Will you offer DCW services in the home of a smoker?
Will you offer DCW services in a home with pets?
.............................Large dogs?
.............................Cats?
Do you have Article 9 certification?
Do you have "Prevention and Support" (CIT) training certification?
Are you CPR certified?
Are you First Aid certified?
Can you provide Tuberculosis free test results?
Do you have Level 1 Fingerprint clearance?

DCW's are required to clear certain background checks. Is there anything in your history that may preclude you from obtaining clearance related to:

  • Child Protective Services background check?
  • Level 1 Fingerprint through the Arizona Department of Public Safety?
  • List of Excluded Individuals and Entities (LEIE) through the Federal govt?

Education

Highest grade completed:

School
Address
Major Studies
Degree, Diploma, License, or Certification
High School
High School Address
Major Studies
Diploma earned
College/University
College Address
Major Studies
Degree or Certificate earned
Vocational/Business
Vocational/Business School Address
Major Studies
License/Certificate earned

Work History

List all work history for the past 10 years, starting with the most recent. All information must be completed. You may attach a resume, but not in place of completing the required information.


JOB 1 (REQUIRED)


JOB 2


JOB 3

Related Work Information

Please describe your availability on the following days (required):

Work Locations: (check all areas you are interested in offering your services as a DCW)

Tucson
Casa Grande
Phoenix

References (Required)

Name
Address
Telephone
Name
Address
Telephone
Name
Address
Telephone
Name
Address
Telephone

Certification & Authorization

The information provided herein is true and correct. I understand that, in the event of contracting with Soreo, my contract may be terminated if any information that I have given herein, or if any other information I provide to Soreo, is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.
I authorize Soreo to inquire into my educational, professional, and past work history and to contact my references as needed to research my qualifications to be a Direct Care Worker. I hereby give my consent to any former employer or contractor to provide work-related information about me to Soreo and will hold Soreo and my former employer/contractor harmless from any claim made on the basis that such information about me was provided or that any contract decision was made on the basis of such information.
I understand that nothing in this Request for Information, the granting of an interview or my subsequent contracting with Soreo is intended to guarantee a contract with Soreo.

I hereby acknowledge that I have read and agree to the above statements.