MAKE THE DOCUMENT WORK FOR YOUR SITUATION
About this caregiver agreement
Record care duties, scheduling, medication boundaries, emergency procedures, expense handling, and reporting. Record who actually employs or engages the worker, the agreed duties, paid working time, wages, payroll, leave, and handover. Household employment and agency arrangements require review of the real working relationship; the signed document alone does not determine worker status.
What the template includes
The online builder and downloaded documents use the same fields. A selected state can add relevant research prompts. Complete only applicable items; add explanations for exceptions rather than assuming a blank entry resolves them.
Document details4 inputs +
Set the date, jurisdiction, and your internal reference.
- Document date *
- US state *
- County
- Document reference
Work location & legal coverage5 inputs +
Record the actual facts, reviewed rule, and supporting references. No answer here certifies a waiver, exemption, restriction, or deadline as valid.
- States where work is actually performed
- Local workforce rules and official references
- Employer size and coverage facts reviewed
- Applicable collective agreement or representation
- Reviewed rule and dated source reference
Pay basis & actual duties5 inputs +
Record the actual facts, reviewed rule, and supporting references. No answer here certifies a waiver, exemption, restriction, or deadline as valid.
- Actual duties and authority used in classification review
- Employee status tests and factual basis reviewed
- Overtime exemption or nonexempt basis reviewed
- Current applicable minimum rate and work date reference
- Hours worked overtime and recordkeeping procedure
Household employer & working time8 inputs +
Record the actual facts, reviewed rule, and supporting references. No answer here certifies a waiver, exemption, restriction, or deadline as valid.
- Who controls duties schedule and manner of work
- Agency and household employer roles reviewed
- Actual live in or visiting arrangement
- Care duties and other household duties with time allocation
- Sleeping waiting and on call periods and interruptions
- Meal and off duty periods and hours recording
- Household payroll tax and employer obligations review
- Required worker rights notice and agreement delivery record
People & organizations8 inputs +
Use legal names and current contact information.
- Hiring household or agency legal name *
- Hiring household or agency address *
- Hiring household or agency email
- Hiring household or agency phone
- Worker legal name *
- Worker address *
- Worker email
- Worker phone
Hiring parties & reviewed engagement model7 inputs +
Identify the actual employer and any agency or shared household roles. Do not infer contractor status from the agreement title.
- Engagement model reviewed *
- Actual employer or joint employer identities *
- Agency household and worker responsibilities
- Hiring signer authority and care permissions
- Worker status facts and reviewed legal framework *
- Work begins *
- Planned end date if any
Care duties, schedule & permissions9 inputs +
Describe the actual childcare or care work and its boundaries. Keep private medical information in a suitable separate record.
- Care recipient name *
- Care location *
- Care duties and limitations *
- Schedule and rest periods *
- Medication support boundaries
- Emergency contact and response plan
- Care log and reporting
- Transportation arrangements
- Qualifications and background checks
Wages, payroll & expenses8 inputs +
Record employment pay terms separately from expense reimbursement. Review the actual work location, pay conditions, and hours before selecting wage or overtime treatment.
- Regular wage rate and pay basis *
- Pay period and regular payday *
- Applicable minimum wage and effective date reviewed
- Overtime treatment actual duties and exemption basis reviewed *
- Payroll withholding and employer tax responsibilities *
- Wage statement and payment delivery procedure
- Approved expenses mileage and reimbursement procedure
- Any proposed deductions and reviewed authority
Working time, rest & leave7 inputs +
Document actual paid time and any reviewed exception. Overnight presence and an agency arrangement do not themselves establish unpaid time.
- Hours and interruption recording procedure *
- Actual living arrangement and agreed living space
- Sleeping waiting on call and interrupted periods *
- Meal rest and off duty arrangements *
- Paid and unpaid leave and required protections *
- Schedule changes additional duties and approval procedure
- Required worker rights notices and agreement delivery reference
Separation, continuity of care & handback6 inputs +
Record the reviewed employment or agency process. Keep earned pay obligations separate from property return and any additional separation payment.
- Notice and separation arrangements under reviewed model *
- Earned wages leave and final pay timing review *
- Care continuity records and emergency handover *
- Keys equipment belongings and permissions handback
- Care information handling and protected rights exclusions
- Pay scheduling or workplace concern contact
Additional details & signing7 inputs +
Add attachments, exceptions, and the names of authorized signers.
- Attachments / supporting records
- Exceptions / additional terms
- First signer printed name
- First signer title
- Second signer printed name
- Second signer title
- Signing date
How to complete it
1. Document details
Set the date, jurisdiction, and your internal reference. Review document date, us state, county, document reference against your source records.
2. Work location & legal coverage
Record the actual facts, reviewed rule, and supporting references. No answer here certifies a waiver, exemption, restriction, or deadline as valid. Review states where work is actually performed, local workforce rules and official references, employer size and coverage facts reviewed, applicable collective agreement or representation and the remaining details against your source records.
3. Pay basis & actual duties
Record the actual facts, reviewed rule, and supporting references. No answer here certifies a waiver, exemption, restriction, or deadline as valid. Review actual duties and authority used in classification review, employee status tests and factual basis reviewed, overtime exemption or nonexempt basis reviewed, current applicable minimum rate and work date reference and the remaining details against your source records.
4. Household employer & working time
Record the actual facts, reviewed rule, and supporting references. No answer here certifies a waiver, exemption, restriction, or deadline as valid. Review who controls duties schedule and manner of work, agency and household employer roles reviewed, actual live in or visiting arrangement, care duties and other household duties with time allocation and the remaining details against your source records.
5. People & organizations
Use legal names and current contact information. Review hiring household or agency legal name, hiring household or agency address, hiring household or agency email, hiring household or agency phone and the remaining details against your source records.
6. Hiring parties & reviewed engagement model
Identify the actual employer and any agency or shared household roles. Do not infer contractor status from the agreement title. Review engagement model reviewed, actual employer or joint employer identities, agency household and worker responsibilities, hiring signer authority and care permissions and the remaining details against your source records.
7. Care duties, schedule & permissions
Describe the actual childcare or care work and its boundaries. Keep private medical information in a suitable separate record. Review care recipient name, care location, care duties and limitations, schedule and rest periods and the remaining details against your source records.
8. Wages, payroll & expenses
Record employment pay terms separately from expense reimbursement. Review the actual work location, pay conditions, and hours before selecting wage or overtime treatment. Review regular wage rate and pay basis, pay period and regular payday, applicable minimum wage and effective date reviewed, overtime treatment actual duties and exemption basis reviewed and the remaining details against your source records.
9. Working time, rest & leave
Document actual paid time and any reviewed exception. Overnight presence and an agency arrangement do not themselves establish unpaid time. Review hours and interruption recording procedure, actual living arrangement and agreed living space, sleeping waiting on call and interrupted periods, meal rest and off duty arrangements and the remaining details against your source records.
10. Separation, continuity of care & handback
Record the reviewed employment or agency process. Keep earned pay obligations separate from property return and any additional separation payment. Review notice and separation arrangements under reviewed model, earned wages leave and final pay timing review, care continuity records and emergency handover, keys equipment belongings and permissions handback and the remaining details against your source records.
11. Additional details & signing
Add attachments, exceptions, and the names of authorized signers. Review attachments / supporting records, exceptions / additional terms, first signer printed name, first signer title and the remaining details against your source records.
Practical tips
- Use the actual working relationship when reviewing worker status; a signed label is not decisive.
- Record interruptions to overnight or on-call periods rather than treating all such hours as unpaid.
- Reference private care records without putting unnecessary medical details into the downloaded agreement.
Before signing or submitting
Review the actual household, agency, or joint employment model. Federal and state worker classification, wages, domestic worker protections, payroll, leave, and final pay can apply. This agreement does not establish contractor status or supply required separate government notices.