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Adult Family Home Caregiver Experience Attestation (CEA) Caregiving Experience Attestation 2025

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The document outlines the requirements for completing the Caregiving Experience Attestation (CEA) form for Adult Family Home (AFH) providers in Washington state. It specifies that applicants must have at least 1,000 hours of direct caregiving experience with vulnerable adults and details who is exempt from this requirement. The form must be completed by an attestor who has personal knowledge of the applicant's caregiving experience, and it must be notarized to be accepted. Additional sections collect information about the applicant and attestor.

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Click ‘Get Form’ to open it in the editor.
Begin with Section 1, where you will indicate your role as either an Applicant, Spouse Co-Provider, Entity Representative, or Resident Manager. Fill in your name and the name and address of the Adult Family Home.
Proceed to Section 2, which is for the attestor. Enter their name, title or role, and provide two contact numbers for them during business hours.
Answer questions regarding the attestor's relationship with the individual named in Section 1. This includes confirming if they currently work together and detailing the care setting.
Complete the remaining fields about caregiving responsibilities and experiences. Ensure all responses are accurate and complete.
Finally, ensure that both the attestor's signature and notary public section are filled out correctly before submitting.

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How to get an adult family home license in Washington state?

To obtain a license from the DSHS, an individual must go through a thorough licensing process, which includes a background check, an inspection of the home, and a review of the proposed care plan. Its important to note that all staff members must also pass a background check.

What is an adult family home in WA state?

These are residential homes licensed to care for up to six non-related residents. They provide room, board, laundry, necessary supervision, and necessary help with activities of daily living, personal care, and social services. RCW 70.128.

How long does it take to get an AFH license in Washington state?

The amount of time it takes to process a license application will vary based on several factors. The application can take 60 days or more to process. A staff person will contact you via email at the email address listed in the application once the Business Analysis Application Unit has received the application.

How to apply as a caregiver in the USA without experience?

EB-3 Visa for Caregivers The EB-3 visa does not require any specific skills, credentials, or experience on the caregivers behalf in order for you to be given the visa to work in the United States. The caregiver must, however, be physically strong and healthy, as well as be able to speak and understand English.

How to open an adult family home in WA state?

Operating an adult family home in Washington State is a responsibility that requires proper training and certification. To obtain a license from the DSHS, an individual must go through a thorough licensing process, which includes a background check, an inspection of the home, and a review of the proposed care plan.

caregiving experience attestation form

AFH application status AFH application checklist AFH licensing requirements Washington State Adult Family Home application Adult Family Home Visitor Log DSHS negotiated care plan form Adult Family Home Incident Log ALTSA AFH

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How much do adult family home providers make in Washington state?

Average Adult Family Home hourly pay ranges from approximately $17.73 per hour for Shift Leader to $23.75 per hour for Residence Manager. The average Adult Family Home daily wage ranges from approximately $281 per day for In Home Caregiver to $376 per day for Caregiver.

Adult Family Home Caregiver Experience Attestation (CEA) Caregiving Experience Attestation 2025

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How to use or fill out Adult Family Home Caregiver Experience Attestation (CEA) Caregiving Experience Attestation

See more Adult Family Home Caregiver Experience Attestation (CEA) Caregiving Experience Attestation versions

Complete this form in 5 minutes or less

Got questions?

How to get an adult family home license in Washington state?

What is an adult family home in WA state?

How long does it take to get an AFH license in Washington state?

How to apply as a caregiver in the USA without experience?

How to open an adult family home in WA state?

Complete this form in 5 minutes or less

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How much do adult family home providers make in Washington state?

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