Become a Home Care Provider

Thank you for your interest in becoming a Home Care Provider with Sunshine Community Care.

Our Home Care Providers make a meaningful difference by offering safe, supportive, and welcoming homes for individuals with developmental disabilities. If you are compassionate, responsible, and committed to helping others live fulfilling lives, we encourage you to apply.

Please complete the application below. Our team will review your information and contact you if your qualifications match our current provider opportunities.

Home Care Provider Application

Sunshine Community Care

Home Care Provider Application

Please complete the application below. Fields marked with * are required.

Section 1 – Personal Information

First Name

Last Name

Email Address

Primary Phone

Secondary Phone

Present Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Gender

Languages Spoken (Optional)

How did you hear about Sunshine Community Care?

Section 2 – Home Information

Have you lived outside New Hampshire during the past 7 years?

Yes

If yes, please list the state(s) and the years you lived there.

Have you ever been a Home Care Provider or Respite Provider?

Yes

If yes, please briefly describe your previous experience.

Do you have a spare bedroom available for the individual you may support?

Yes

Would you consider moving for a placement?

Yes

Maybe

Household Members

Please list everyone currently living in your home other than yourself.

Household Member 1 – Name

Age

Gender

Relationship to Applicant

Household Member 2 – Name

Age

Gender

Relationship to Applicant

Household Member 3 – Name

Age

Gender

Relationship to Applicant

Are there any pets living in the home?

Yes

If yes, please describe the pets living in the home.

Section 3 – Driver and Insurance Information

Do you have a valid driver’s license?

Yes

State of Issue

Driver’s License Number

Do you currently have automobile insurance?

Yes

Automobile Insurance Carrier

Do you currently have homeowners or renters insurance?

Yes

Homeowners or Renters Insurance Carrier

Proof of driver’s license and insurance may be requested later during the provider onboarding process.

Section 4 – Background Information

Please answer the following questions honestly. A background check may be required before placement.

Have you or anyone living in your household ever been convicted of a felony or misdemeanor?

Yes

If yes, please explain.

Have you or anyone living in your household ever been convicted of, or found responsible for, abuse, neglect, exploitation, or a substantiated rights violation?

Yes

If yes, please explain.

Are you or anyone currently living in your household currently under investigation by any protective services agency or law enforcement agency?

Yes

If yes, please explain.

I understand that Sunshine Community Care may conduct criminal background, driving record, and other required screening checks before approval as a Home Care Provider.

Section 5 – Education and Qualifications

Please provide information about your education, training, and relevant qualifications.

Highest Level of Education Completed

High School Name

City and State

Did you graduate?

Yes

Year Graduated

College or University

College or University Name

City and State

Major or Field of Study

Degree Earned

Dates Attended

Did you graduate?

Yes

Currently Enrolled

Trade School, Certification, or Other Training

School or Training Program

Certificate or Credential

Please select any current certifications you hold.

CPR

First Aid

Medication Administration

MOAB

MANDT

Other

None

If you selected Other, please list the certification.

What qualifications or personal qualities would help you succeed as a Home Care Provider?

What interests you most about working with individuals with developmental disabilities?

Section 6 – Employment History

Please provide your most recent employment information.

Current or Most Recent Employer

Employer Name

Job Title

Employer Phone Number

Supervisor Name

Start Date

End Date

Current Employment Status

I currently work here.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Primary Job Duties

Reason for Leaving

May Sunshine Community Care contact this employer?

Yes

Please describe any caregiving, healthcare, human services, volunteer, or personal experience relevant to this position.

Section 7 – Emergency Contact Information

Please provide at least one person we may contact in case of an emergency.

Emergency Contact First Name

Emergency Contact Last Name

Relationship to Applicant

Primary Phone Number

Secondary Phone Number

Emergency Contact Email Address

Emergency Contact Address

I authorize Sunshine Community Care to contact the person listed above in the event of an emergency.

Emergency contact information will be used only when necessary and will be handled confidentially.

Section 8 – Applicant Certification and Agreement

Please read the statements below carefully before submitting your application.

Applicant Certification

I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge.

Background Check Authorization

I understand that Sunshine Community Care may conduct criminal background, driving record, reference, and other required screening checks before approving my application.

Employment Understanding

I understand that submitting this application does not guarantee approval or placement as a Home Care Provider.

Privacy Acknowledgement

I understand that the information I provide will be used only for evaluating my application and will be handled confidentially.

Electronic Signature (Type Your Full Name)

Today's Date

By submitting this application, you certify that all information provided is accurate and complete. Sunshine Community Care will review your application and contact you if additional information is required or if your qualifications match current provider opportunities.