Print a blank Caregiver Application form
You may use this as a worksheet or submit it via fax or mail
Make sure your browser's zoom function is set to 100%.
To print the form (or
Please make sure you have provided all relevant information. Incomplete or missing information may result in an unsuccessful background check.
To the full extent permitted by law, I shall hold harmless, defend at my own expense, and indemnify the County of Napa and the Area Agency on Aging Serving Napa and Solano and their officers, agents, employees and volunteers from any and all liability, claims, losses, damages or expenses, including reasonable attorney fees, for personal injury (including death) or damage to property, arising from all acts or omissions of the applicant. I understand that all fees are non-refundable. I also certify, under penalty of perjury under the laws of California, that the information on this page is true and correct.