Personal Care Worker Application

To start your personal care worker application, please complete and return our Heritage Health Services Employment Application and the Background Check Release form.

You will need the free program, Adobe Acrobat, to view, fill out and print the forms below. 

After completing your forms, there are various ways to return them to us:

1. Save the completed forms to your hard drive and email them to us at

2. Print and Fax the completed forms to us at 262-222-0088

3. Print the forms and bring them to our office located at 6634 Durand Ave. in Racine

4. Print and Mail the completed forms to us via snail mail at 6634 Durand Ave. Racine, WI 53406

PCW Application    Background Check Authorization  Background Information Disclosure


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