We request this information for the purpose of confirming your identity and Florida licensing requirements.  Please note that your personal documentation will remain secure. If you have any questions about the form or how to complete it, please contact us.

Personal Verification Documents

  • Social Security Card
  • Driver’s License or State Identification Card
  • Auto Insurance
  • Work permit, if needed, with Passport and Alien Card
  • Liability insurance
  • COVID-19 Vaccine/Flu Vaccine
  • Physical Exam
  • PPD or Chest X-ray (TB)

Regarding your personal documents, we offer two options to deliver these documents.

Option #1: Document upload

Option #2: Compressed Zip File via email.

Email Address: HR@tricountyhomecare.com

ZIP File Name: LastNameFirstInitial_PVD

Please complete the form below, upload the requested documents and submit. Documents that are uploaded must be less than 5 MB per file and in one of these formats: jpg, jpeg, pdf, png. 

If you choose Option #2, please indicate that choice on the form below.