(561) 858-8699
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Health Care Provider / Employer Name:
Helios Home Health
Address of Health Care Provider:
500 Gulf Stream Blvd., Ste. 207
Delray Beach, FL 33483
Attestation
Under penalty of perjury, I,
hereby swear or affirm that I meet the requirements for qualifying for employment in regards to the background screening standards set forth in Chapter 435 and section 408.809, F.S. In addition, I agree to immediately inform my employer if arrested or convicted of any of the disqualifying offenses while employed by any health care provider licensed pursuant to Chapter 408, Part II F.S.
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