Travel Agreement
(For ALL non-service applicants)

As a stipulation to apply with AccuCare Home Health Services, it is required that you are able to travel to patients’ homes in the company’s service areas. This requires you to have your own form of reliable transportation. By signing this agreement, you are stating that you have your own transportation and are willing to travel to one of the following zones for work/cases. Please select one primary work location:
I am willing to travel 30 minutes or more for a case:* Yes:    No: 
I am willing to do live in cases (minimum case of 24 hours):* Yes    No: 
 
  Cohoes Zone (Cohoes, Green Island, Watervliet, Albany 12204)
  Albany Zone (12201, 12202, 12203, 1220612207, 12208, 12209, 12210, 12214)
  Colonie Zone (Latham, Newtonville, Albany 12205, 12211, 12212, 12220)
  Troy Zone (12180, 12181, 12182)
  Rensselaer Zone (East Greenbush, Rensselaer, Wynantskill)
 
  I understand that by signing this agreement I am stating that I have transportation and am able and willing to travel to one of these areas for work/cases
   
APPLICANT                  COMPANY REPRESENTATIVE
Name * :  Name  :  
Signature*  

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Date: 
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