PCA Experience Attestation

PCA Applicant Information

Applicant Full Name

Position Applied For

Application Date

Person(s) Responsible for Hiring

Full Name

Title / Position

Email

Phone

Date

Acknowledgment of Elements to Verify for PCA Previous Experience

I acknowledge that I have reviewed and understand that all of the following elements must be verified when checking the previous experience of a PCA applicant:

I understand that a Personal Care Assistant (PCA) applicant's previous experience must be verified to confirm they have the required skills and competency to provide personal care services to consumers.I will verify the applicant's previous employer(s) by contacting each employer listed on the employment application directly, using a verified phone number obtained independently (not solely the number provided by the applicant).I will verify the applicant's dates of employment (start and end) with each previous employer to confirm the experience claimed on the application is accurate.I will verify the specific job duties and responsibilities performed by the applicant, including whether they included personal care tasks such as bathing, dressing, grooming, toileting, transfers, meal preparation, and medication assistance.I will speak directly with the applicant's former supervisor(s) — not just HR or a coworker — to obtain first-hand information about the applicant's performance, reliability, and suitability for the PCA role.I will verify the reason for leaving each previous position to identify any patterns of misconduct, abandonment, or termination that may disqualify the applicant.I will ask each previous employer whether the applicant is eligible for rehire, as a negative response may indicate performance or conduct issues requiring further investigation.I will inquire about the applicant's overall performance, attendance, punctuality, interpersonal skills with consumers and staff, and ability to follow care plans and instructions.I understand that I must verify the applicant has actual prior experience providing personal care services (as a PCA, STNA, nursing assistant, home health aide, or similar role) — not just general work history.I will document all verification efforts in writing, including: employer name, contact person, phone number, date of contact, information obtained, and the verifier's signature. This documentation will be retained in the applicant's personnel file.I will verify the applicant's personal and professional references by contacting at least two (2) references provided on the application, documenting their relationship to the applicant, length of time known, and their assessment of the applicant's character, reliability, and suitability for the PCA role.I will verify that the applicant holds all required certifications for the PCA role, including a valid State-Tested Nursing Assistant (STNA) certificate (if required), current CPR / First Aid certification, and any other credentials required under OAC 173-39-02.12. I will obtain copies of all certifications, verify their validity with the issuing organization, and confirm expiration dates are tracked for renewal.I understand that if previous experience cannot be verified, if the applicant provides false information, or if a previous employer reports misconduct, the applicant may be disqualified from employment as a PCA at Dulla Care Home Healthcare.I understand that if an applicant is hired conditionally pending verification, all previous experience must be verified within 60 days of hire per Dulla Care policy, and failure to verify will result in removal from service.

⚠ Please review and acknowledge all items above.

Attestation

I, [Full Name], in my capacity as [Title]and as the person(s) in charge of hiring at Dulla Care Home Healthcare, hereby attest that I have reviewed and understand all elements that must be verified when checking the previous experience of a Personal Care Assistant (PCA) applicant, as outlined above. I understand that thorough verification of previous experience is required under OAC 173-39-02.12(J) and that failure to verify any element may result in hiring an unqualified individual, which may jeopardize consumer safety and agency compliance. I commit to verifying all elements for every PCA applicant before or within 60 days of hire, and to documenting all verification efforts in the applicant's personnel file.

PCA Applicant Previous Experience Verification Attestation

PCA Applicant Information

Person(s) Responsible for Hiring

Acknowledgment of Elements to Verify for PCA Previous Experience

Attestation

Witnessed By (Administrator)