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Online Application

Please fill-out the following form if you are interested in being a caregiver with Champion Home Health Care. You will be contacted by us after we have reviewed your submission.

Initial HHA contractor application
  • Name*full name
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  • Address*full address
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  • Email*a valid email address
    2
  • Phone*
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  • Date of birth*
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  • Social Security #*
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  • Check those of which you have a valid, current copy.*
    Florida CNA License
    AHA or Red Cross CPR Certificate
    Social Security Card
    Driver's License
    Auto Insurance
    Passport
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  • Availability:
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  • Please describe your weekly availability*including weekends
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  • References
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  • Name 1*full name
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  • Phone 1*
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  • Name 2*full name
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  • Phone 2*full name
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  • Please list three most recent client, contractees or employees.
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  • Company Name 1*
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  • Supervisor/Client Name 1*
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  • Dates of Work 1*Enter range
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  • Contact Phone 1*
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  • Company Name 2*
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  • Supervisor/Client Name 2*
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  • Dates of Work 2*Eneter range
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  • Contact Phone 2*full name
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  • Company Name 3*
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  • Supervisor/Client Name 3*full name
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  • Dates of Work 3*
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  • Contact Phone 3*
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  • Emergeny Contact Name*full name
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  • Emergeny Contact Number*
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  • DL State*
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  • DL Exp Date*
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  • Name as it appears on Social Security Card*full name
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  • Driver’s License #*
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  • Thank you for providing the information to get you started with Champion Home Health Care. What to expect now:
    1. Please expect a call from one of our hiring managers to set you up for an interview.
    2. After the interview, you will be set up to do the initial in-services and written test that Champion requires. You will also take an on-line course to explain the procedures the contractors need to follow when providing services to the clients.
    3. The sooner you complete the training, the sooner we can schedule your meet and greet with the office staff and be on your way to providing care through the best home health agency in the region. We automatically receive notification of your successful completion of all the in-services and training.
    4. We will call you to set up the meet and greet. We expect you to dress in scrubs (any color) and attire like if you were going to work. Please bring the following items to your meet and greet
      • Blue pen
      • Phone
      • Driver's license
      • Social security card or passport/other acceptable gov't ID card auto insurance
      • AHA or red cross CPR card
      • FL CNA certificate or 75 hr HHA certificate
    Plan to be here for an hour for the informational meet and greet.
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