Regional Center:
Select
Regional Center of the East Bay, Inc.
Redwood Coast Regional Center
My Name :
Regional Center Client :
Regional Center Client :
My Email Address :
Relation to Client :
Mother
Father
Guardian
Questions about the Worker :
Is the worker 18 years or older?
Yes
No
Does the worker live outside the home of the client?
Yes
No
Will you personally recommend the worker by signing the Manos Home Care worker recommendation form?
Yes
No
If the answer is 'yes' to all three questions, we will:
Interview the worker
Check the worker's criminal background
Verify work eligibility by filling out the federal government's I9 form.
After the worker is cleared, the worker can start. The form must be filled out prior to the employment of the worker.
Worker Information :
Other workes on the case :
Are any workers being removed from the case?
Yes
No
If yes, who? Worker Name:
Register Email Address :
If you have not registered your email address with Manos Home Care, please call 510-336-2900 so we can keep your email address on file to ensure the confidentiality of your information and your action requests.