Employment Agency Self-Certification - Nyc Department Of Consumer Affairs Page 9
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20Section 6: Domestic or Household Employees: Statement of Employee
Rights and Employer Responsibilities
Code Section 20-771
I will place job applicants as Class A domestic or household workers and will give each applicant
DCA’s “Domestic or Household Employees: Statement of Employee Rights and Employer
Responsibilities.” The statement is available for download at nyc.gov/BusinessToolbox.
I will maintain at my agency and have available for inspection by DCA, for three years, proof that I
issued a statement to each applicant I placed as a Class A domestic or household worker.
Section 6 does not apply to my agency.
Section 7: Cards to be Furnished to Nurses and Nurses’ Registry
GBL Section 182
I will place job applicants in Class D nursing engagements and will give to each applicant I place a
card that includes all of the following:
The applicant’s name, address, and salary AND
Whether the applicant is a registered professional nurse or licensed practical nurse AND
The number of the current registration certificate issued to the applicant by the education
department AND
A statement that the applicant’s record of educational qualifications and experience in the
practice of nursing is on file in my agency’s registry and that a copy will be sent to the
employer upon request AND
Name, address, and DCA license number of my agency AND
The word “agency”
I will maintain at my agency and have available for inspection by DCA a nurses’ registry of all
applicants I send to practice nursing. The registry will include all of the following:
A record of my agency’s investigation and verification of an applicant’s educational
qualifications, licensure, and current registration AND
At least two current written references for the applicant AND
A copy of every card I give to an applicant
Section 7 does not apply to my agency.
Revised 09/19/14
Page 9 of 20
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