Edit, Download, and Sign the Washington State Home Care Aide Certification Application
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How do I fill this out?
To fill out the Home Care Aide Certification Application, carefully read all instructions and requirements included in the packet. Ensure you complete each required section in ink and provide accurate information. Gather any necessary documentation and include it with your application.

How to fill out the Washington State Home Care Aide Certification Application?
1
Carefully read all instructions and requirements.
2
Complete each required section in ink.
3
Provide accurate information.
4
Gather any necessary documentation.
5
Include all documents with your application.
Who needs the Washington State Home Care Aide Certification Application?
1
New home care aides needing certification for employment purposes.
2
Employers requiring verification of home care aide certification.
3
Individuals seeking recertification or renewal of their home care aide license.
4
People applying for a provisional home care aide certificate.
5
Foreign-trained caregivers needing certification recognition in Washington State.
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What are the instructions for submitting this form?
To submit the Home Care Aide Certification Application, mail the completed form along with initial documentation and payment to: Department of Health, Home Care Aide Credentialing, P.O. Box 1099, Olympia, WA 98507-1099. Send additional documents not included with the initial application to: Home Care Aide Credentialing, P.O. Box 47877, Olympia, WA 98504-7877. For further assistance, contact Home Care Aide Credentialing at 360-236-2700 or the Customer Service Center at 360-236-4700.
What are the important dates for this form in 2024 and 2025?
Important dates for this form include: June 2024, when the current version of the instructions was last updated, and February 2024, when the Social Security Number requirements were revised. Ensure all training and certification are completed within 200 days of the hire date.

What is the purpose of this form?
The purpose of the Home Care Aide Certification Application form is to ensure that individuals seeking to become home care aides in Washington State meet all regulatory requirements. This includes completing the necessary training, submitting background checks, and passing certification exams. The form also serves to verify employment and eligibility for provisional certification.

Tell me about this form and its components and fields line-by-line.

- 1. Applicant Information: Includes personal details such as name, contact information, and social security number.
- 2. Employment Verification: Requires the employer's confirmation of the applicant's job status and hire date.
- 3. Background Check: Includes instructions for completing a fingerprint-based background check through DSHS.
- 4. Training Details: Requires information on the completed 75-hour basic training course approved by DSHS.
- 5. Certification Examinations: Details the requirements for passing the knowledge and skills certification exams.
What happens if I fail to submit this form?
Failing to submit the Home Care Aide Certification Application may result in the inability to legally work as a home care aide in Washington State. It is crucial to complete and submit all required forms and documents to avoid delays or disqualification.
- Employment Ineligibility: You may not be able to work as a home care aide without proper certification.
- Delayed Certification: Failure to submit the form on time may delay the certification process.
- Non-Compliance Penalties: You may face penalties for not adhering to state regulations regarding home care aide certification.
How do I know when to use this form?

- 1. New Certification: For first-time applicants seeking certification as home care aides.
- 2. Renewal: For individuals who need to renew their existing home care aide certification.
- 3. Provisional Certification: For those applying for a temporary provisional certification while completing requirements.
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