SEIU ULTCW Homecare Exchange | Home Care Exchange

Welcome to the Home Care Exchange

A free service that pairs CA home care providers with those in need of care

Home Care Exchange For Care Providers: If you’re a home care provider in search of more hours or new clients, please read on.

For Care Recipeints: If you’re someone interested in receiving in-home care, or you’re helping someone who is, please follow this link: Homecare Exchange for Consumers.

How The Exchange Service Works

1) Submit an application online, via phone or by mail. (Details in the section below)

2) After you've submitted your application, one of our specialists will search our database for a care recipient whose needs matches your skills, experience, and preferences.

3) Once they’ve found a match, our specialists will contact you and help you contact the care recipient.

How to Apply

Choose one of the following methods:

Online: Fill out the application to the right. (Required fields marked with a red asterisk)

Phone: Call our hotline at 1-866-544-5742.

Mail: Download one of the the following applications: English | Spanish | Chinese | Armenian

(To download, right-click any of the files above select "Save as / Save Target As.")

Print out the document and fill out the all fields. Mail the completed application to the following address:

SEIU ULTCW
Attn: Manual Tapia
2515 Beverly Blvd
Los Angeles, CA 90057

Important:

Whether you apply online, via phone or by mail, you must submit the following documents along with your application. If you don't submit these applications, we won't be able to process your application.

1) Photocopy of the letter from the Personal Assistance Service Council (PASC) stating either that you passed your background check; or that you are not required to undergo a new background check.

2) Photocopy of your California driver’s license or identification card

3) Photocopy of your social security card

4) Photocopy of a check stub with a deduction for union dues

Mail the documents to the above address.

Any questions? Call our hotline 1-866-544-5742. Or email Manny Tapia at manualta@seiu-ultcw.org

Email *

First Name *

Middle Name

Last Name *

Address *

City *

State/Region/Province *

Zip/Postal Code *

Home phone *

Cell phone *

Social Security # *

Driver's License # *

Gender *

Emergency contact name *

Emergency contact phone *

Relationship to yourself (i.e. friend, brother) *

What languages do you speak?

Primary *

Secondary

Other

Are you willing to avoid using scented fragrances on the job? *

Are you willing to work for a care recipient with a dog? *

Are you willing to work for a care recipient with a cat? *

Are you willing to work at a home where there is a smoker? *

Are you willing to comply with a no-smoking rule at your care recipient’s home? *

How many hours are you currently working per month? *

How many additional IHSS hours do you wish to work per month?. *

Would you be willing to work for a non-IHSS (private pay) client? *

Do you have a car that can be used for work? *

Check the days and times when you might be willing to schedule services

Monday

   Morning
   Afternoon
   Evening
   Overnight
   Live-in
   On-call

Tuesday

   Morning
   Afternoon
   Evening
   Overnight
   Live-in
   On-call

Wednesday

   Morning
   Afternoon
   Evening
   Overnight
   Live-in
   On-call

Thursday

   Morning
   Afternoon
   Evening
   Overnight
   Live-in
   On-call

Friday

   Morning
   Afternoon
   Evening
   Overnight
   Live-in
   On-call

Saturday

   Morning
   Afternoon
   Evening
   Overnight
   Live-in
   On-call

Sunday

   Morning
   Afternoon
   Evening
   Overnight
   Live-in
   On-call

Educational Background: Indicate the highest level reached

Grade school

Middle School

College

Major

Homecare Employment History: Please list below each care recipient you have worked for within the last three years.

1) Name of Care Recipient

1a) Date from (mm/dd/yyyy):

1b) Date to (mm/dd/yyyy):

1c) Reason for ending service:

1d) Phone number of care recipient (if available):

1e) (If care recipient not available -- name and phone number of recipient family member:

2) Name of Care Recipient

2a) Date from (mm/dd/yyyy):

2b) Date to (mm/dd/yyyy):

2c) Reason for ending service:

2d) Phone number of care recipient (if available):

2e) (If care recipient not available -- name and phone number of recipient family member:

3) Name of Care Recipient

3a) Date from (mm/dd/yyyy):

3b) Date to (mm/dd/yyyy):

3c) Reason for ending service:

3d) Phone number of care recipient (if available):

3e) (If care recipient not available -- name and phone number of recipient family member:

Personal References (Do not include relatives)

1st reference

Name: *

Address:

Primary phone *

What is your relationship to this person? *

2nd reference

Name:: *

Address::

Primary phone:: *

What is your relationship to this person?: *

I certify under penalty of perjury that the information provided above is true to the best of my knowledge. I also understand that any misrepresentation on my part may result in disqualification or removal from the Homecare Exchange at any time. I further authorize the Homecare Exchange and/or the care recipient to contact the above employers and references concerning my work and character. By checking this box, I also certify that I have read the Participant's Rights, Responsibilities and Release. Click here to read the release *

* denotes required field

© SEIU United Long Term Care Workers
2515 Beverly Blvd. Los Angeles, CA 90057 | 888-373-3018
Service Employees International Union, CTW, CLC Privacy Policy