To apply as a caregiver in the USA, you need to be legally authorized to work, complete an approved training program of at least 75 hours, pass a fingerprint-based criminal background check, assemble your identity and health documents, and submit an application to your state’s nurse aide or home care aide registry. The sequence is the same across states even though the fees, forms, and extra hours on top of the federal minimum vary. Get the worker-classification and tax piece right at the start, because that decision follows you into every paycheck.
Are You Eligible to Work as a Caregiver
Most professional caregiving jobs require you to be at least 18. A handful of states allow 16-year-olds into limited roles, but plan around 18 as the working standard, because the work involves medication, physical transfers, and legal responsibility for vulnerable people.
You also need authorization to work in the United States. Citizenship is not required. A Green Card, an Employment Authorization Document, or a valid work visa that covers healthcare employment will satisfy the rule. Your employer verifies this through Form I-9, which accepts a U.S. passport, a Permanent Resident Card, an EAD, or a foreign passport with proper work endorsement, among other combinations.1U.S. Citizenship and Immigration Services. Handbook for Employers M-274 – 13.0 Acceptable Documents for Verifying Employment Authorization and Identity Have your documents in hand on or before your first day.
Complete an Approved Training Program
Federal rules set a floor of 75 hours for both Certified Nursing Assistants and Home Health Aides. For CNAs in Medicare- or Medicaid-certified nursing facilities, at least 16 of those hours must be supervised hands-on practice with a real person under a nurse’s direct supervision, and another 16 hours of classroom instruction must happen before you ever have direct resident contact.2eCFR. 42 CFR 483.152 – Requirements for Approval of a Nurse Aide Training and Competency Evaluation Program Home Health Aides fall under a parallel 75-hour minimum with the same 16-and-16 split.3eCFR. 42 CFR 484.80 – Home Health Aide Services
In practice most programs run 100 to 150 hours because states are free to require more than the federal minimum. Curriculum covers hygiene, nutrition, infection control, safety, communication, and how to observe and report changes in a patient’s condition. After training you sit for a competency evaluation that has two parts: a written or oral exam and a practical skills demonstration.
You will also need current CPR and First Aid certification from a recognized provider such as the American Red Cross or the American Heart Association. A Red Cross CPR certification is valid for two years, then requires an abbreviated renewal course.4American Red Cross. CPR Renewal and Recertification Don’t let it lapse between finishing your course and applying to the registry; an expired card can hold up placement or cost you a job offer.
Pass the Background Check
A clean criminal record is non-negotiable for most caregiving roles. Federal regulations require a fingerprint-based FBI search, a state criminal records check, and a search of sex offender registries.5Child Care Technical Assistance Network. 1.2.0.2 Background Screening Many states also cross-reference child abuse and neglect registries. The FBI portion runs through the Next Generation Identification System.
Fingerprinting is usually done at a Live Scan location, where an electronic scanner captures your prints and transmits them to state and federal databases. Bring the agency-specific form your employer or state registry provides, because the routing codes on it determine where your prints go. Costs vary by state, running from nothing to about $100. Schedule this early: results can take several weeks.
Some convictions permanently disqualify you. The federal Office of Inspector General maintains a List of Excluded Individuals and Entities, and anyone on it cannot work in a role touching Medicare, Medicaid, or other federal health programs. Mandatory exclusion is at least five years for healthcare fraud, patient abuse or neglect, controlled-substance felonies, or theft related to healthcare programs.6U.S. Department of Health and Human Services, Office of Inspector General. Exclusions Authorities A second offense doubles the term to ten years; a third is permanent. Employers check the list during hiring.
Gather Your Documents
Applications stall most often at the paperwork stage. Assemble everything before you open the form:
- Government-issued photo ID: driver’s license, state ID, or passport.
- Social Security card or number, needed for the background check and tax reporting.
- Proof of education: a high school diploma or GED certificate.
- Official training program transcripts showing completion of the required hours.
- Current CPR and First Aid certification cards from a recognized provider.
- Health screening results, including a recent tuberculosis test and up-to-date immunizations per CDC guidance for healthcare workers. Some states also want a physician’s statement that you can perform caregiving tasks.7Child Care Technical Assistance Network. 7.2.0.3 Immunization of Caregivers/Teachers
- Background check authorization form from your state Department of Health or registry portal.
Names must match across every document. If your training certificate says “Katherine” and your license says “Kate,” that mismatch alone can trigger a delay. Health screenings generally need to be less than a year old at submission, so don’t get your TB test six months ahead and sit on it. Submitting false information can result in denial and criminal consequences.
Submit the Application
Most states run an online portal through the Department of Health or a dedicated caregiver registry. Online submission is faster and gives you a tracking number or confirmation email. Paper applications are still accepted in some states but move more slowly. Fees range from nothing to a modest processing charge, on top of fingerprinting costs.
Once you submit, the state verifies your training transcripts directly with the school and checks your name against the state nurse aide registry for prior findings of abuse, neglect, or misappropriation of resident property.8eCFR. 42 CFR 483.156 – Registry of Nurse Aides FBI and state background results come back separately. The full review typically takes two to six weeks, longer when volumes are heavy or documents are missing.
When everything clears, your name is added to the state’s public registry. That listing is your official credential and the record employers check before offering you a position. Watch your email and the portal during review. If the state asks for additional documents and you don’t respond promptly, your file may be closed.
Employee or Independent Contractor
How you’re classified determines who withholds taxes and who owes them. Get this right from day one, because misclassification bites both sides.
If a family hires you directly and controls when, where, and how you work, you are almost certainly a household employee. Once a household employer pays you $3,000 or more in cash wages during the 2026 calendar year, they must withhold and pay Social Security and Medicare taxes on those wages.9Internal Revenue Service. Publication 926 (2026), Household Employer’s Tax Guide The employee share of that FICA combination is 7.65 percent, and the Social Security portion applies to wages up to $184,500. Federal income tax withholding is optional for household employers; if they don’t withhold and you don’t set money aside, you’ll owe it at filing time.
If you run your own caregiving business, set your own hours, work for multiple clients, and supply your own equipment, you may legitimately be an independent contractor. In that case nobody withholds for you. You report income on Schedule C and pay self-employment tax, covering both the employer and employee shares of Social Security and Medicare, on Schedule SE.10Internal Revenue Service. Family Caregivers and Self-Employment Tax You’ll also need to make quarterly estimated tax payments.
Receiving a 1099 when you should be getting a W-2 leaves you carrying the full self-employment tax instead of splitting FICA with the employer. If the classification is unclear, either party can file IRS Form SS-8 for an official determination.
Staying on the Registry
Getting listed is the start. Federal regulations require nurse aides to maintain active status by working in a paid nursing role under the supervision of a registered nurse or licensed practical nurse during each 24-month certification period. Go 24 consecutive months without qualifying work and your name is removed; getting back on means retraining or passing a new competency evaluation.8eCFR. 42 CFR 483.156 – Registry of Nurse Aides
Most states also require continuing education. The federal floor is 12 hours of in-service training per year, though many states set the number higher. Common required topics include infection control, dementia care, and resident rights. Keep every certificate of completion; auditors and employers will ask for proof.
If Your Application Is Denied
A denial isn’t necessarily final, but you have to act fast. The written notice will state the reason, typically a disqualifying criminal record, unverifiable training credentials, or incomplete documentation, and it will include your appeal rights and deadline, often 30 days or less.
Start by requesting a copy of your background report. Errors in criminal history databases are more common than most people expect, and if the denial rests on a record that isn’t yours or is inaccurate, you can dispute it. Write to the state agency’s background screening unit, include proof of identity, and ask for the report. If the record is accurate but you think circumstances warrant an exception, some states hold exemption hearings where you present evidence of rehabilitation; the strongest cases involve old, non-violent convictions unrelated to healthcare, and outcomes are case-by-case.
Findings of abuse, neglect, or misappropriation of property are the hardest to overcome. Under federal rules, these stay on the nurse aide registry permanently unless the original finding was made in error or you were found not guilty in court.8eCFR. 42 CFR 483.156 – Registry of Nurse Aides You have the right to attach a written statement disputing the finding, which becomes part of your registry record, but the finding itself remains visible to employers.