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Application for Independent Contract Caregivers

Thank you for taking time to complete this membership application and for your interest in accepting referrals as an independent caregiver registered through VNA Northwest Nursing Registry, Inc.

VNA Northwest Nursing Registry, Inc. is a private duty home care referral agency dedicated to matching your professional care-giving talents to residents throughout Litchfield County who need temporary or ongoing assistance. We do not employ freelance independent caregivers registered with our agency. You are therefore not entitled to worker's compensation insurance or unemployment compensation. All caregivers and service providers referred through us are paid directly by the clients they work for and are either a self employed independent contractor (IRS Form 1099) or are employed by their clients (IRS Form W-2). As a self employed independent caregiver, you are responsible for paying your own taxes on the income you earn from your clients who you will bill directly. Clients who have engaged the services of a third party payroll processing company to handle payments and tax forms on their behalf will arrange for you to be paid directly on their behalf each week after you have completed and submitted the payment services enrollment forms.

If Registry membership is realized and as required by the State of Connecticut, independent caregivers must supply us with at least TWO (2) of the following credentials to support their independent business status: Professional liability insurance is required. Additional forms of credentialing include a Tax ID number, printed business card, published advertisements for services provided by you, letterhead stationary or a copy of bill or invoice with your name or business name. THESE CREDENTIALS WILL BE NEEDED BEFORE YOU ARE ACTIVELY REFERRED FOR CLIENT ASSIGNMENTS.

Please thoroughly complete all information requested in this application, including full mailing addresses.

  Download a PDF version of our application
Revised January 2018
Areas we serve:
Bantam, Barkhamsted, Bethlehem, Bridgewater, Cornwall, Colebrook, Falls Village, Goshen, Harwinton, Kent, Lakeville, Litchfield, Morris, New Hartford,
New Milford, New Preston, Norfolk, Northfield, North Canaan, Plymouth, Roxbury, Salisbury, Sharon, Terryville, Thomaston, Torrington,
Warren, Watertown, Washington, Washington Depot, West Cornwall, Winchester, Winsted, Woodbury