Request for Training Waiver Confirmation

To Whom It May Concern:

All Crescent Home Care LLC In-Home Service Workers are required to complete twenty (20) hours total of Basic Orientation Training (19 CSR 15-7.021 and 13 CSR 70-91.010). A minimum of eight (8) hours of classroom training must be completed within thirty (30) days of employment and prior to any contact with any Crescent Home Care LLC client.

Crescent Home Care LLC may be able to waive twelve (12) hours of the required Basic Orientation Training for the potential employee below if adequate documentation exists that he/she has received similar training during the current of preceding state fiscal year, or has been employed as an In-Home Health Aide with in In-Home Health agency at least half-time for six months or more, within the current or preceding state fiscal year. In-Home Health Aides will still be required to complete eight (8) hours of classroom training, which includes the two (2) hours of Agency Orientation.

The potential employees name and signature are listed below to verify their agreement with us requesting this information. Please provide the following information, your time and consideration are appreciated.

Name and Signature of Trainer and/or employer designee:

Clear Signature
MM slash DD slash YYYY

Clear Signature
MM slash DD slash YYYY
221 Clarkson Executive Park
Ellisville, MO 63011
(314) 741-3800 phone
(314) 741-3801 fax