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Click ‘Get Form’ to open the worker registration form in the editor.
Begin by selecting your registration type. Check all applicable boxes, especially if you are registering for Long Term Care/Personal Care. Make sure to complete the subcategory section if necessary.
Enter your Social Security Number accurately, as this is required for background checks. Remember to mail a copy of your Social Security card along with the form.
Fill in your personal information, including your last name, first name, middle name, and any other names used. Don’t forget to include your date of birth and gender.
Provide your contact information, ensuring that the street address differs from your employer's address. Include a valid phone number and email address if available.
If applicable, list your current or potential employer details in the designated section. If you are not currently employed, select an appropriate option from the provided choices.
Review the registration agreement carefully before signing and dating the form. Your signature authorizes background checks and confirms that all information is accurate.
Finally, submit your completed form along with a photocopy of your Social Security card and payment to the Missouri Department of Health and Senior Services.
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