Application for home care aide registration - CCLD - State of 2026

1. Click ‘Get Form’ to open the application for home care aide registration in the editor.
2. Begin by entering your name (Last, First, Middle) and your ID number in the designated fields. Ensure accuracy as this information is crucial for processing your application.
3. Fill in your residence address, including street address, apartment number (if applicable), city, state, zip code, and county. If your mailing address differs from your residence address, complete that section as well.
4. Provide your daytime and evening telephone numbers. This information helps ensure that you can be contacted regarding your application status.
5. Review the disclosure section regarding personal information sharing. If you wish to opt-out of having your information shared with labor organizations, check the appropriate box.
6. Sign and date the form at the bottom of page two to confirm that all statements are correct to the best of your knowledge. Remember to include both pages when submitting.

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