Pennsylvania state regulations require that all direct care workers provide documentation of their child abuse clearance prior to working in a home care agency where children reside in their home or in a consumer's home, or acknowledge and sign the following statement pertaining that no children reside in their home.

By ticking the box below, I consent to Neoly Home Care, LLC conducting the following checks as part of my employment application: FBI Criminal Background Check (Child Abuse Clearance); PA Child Abuse History Clearance; PA State Police Criminal History Check (PA PATCH); Welfare Exclusion Check (Medicaid/Medicare eligibility); FBI Fingerprint Check (if a PA resident for less than 2 years).

I also consent to undergo a Tuberculosis (TB) test as required for employment. I agree to provide necessary health information and cooperate with follow-up if needed.

I understand these screenings are mandatory to ensure client safety. I release Neoly Home Care and involved agencies from liability related to this process. I consent to the use of results for employment evaluation.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.