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Menu
Home
About Us
About Us
Testimonials
FAQ’s
Blog
Home Care
Home Care
Medicaid Planning
Private Pay
Pediatrics
CDPAP
NHTD
NHTD
TBI
Work For Rockaway
Work With Rockaway
Employee Links
Keeper
Rockaway Rewards
Employee Referral Program
Forms
FSA Card(Melody)
Get Verified
Contact
516-239-8693
Rockway Home Care is
Expanding To Nassau & Suffolk County!
Now it's
Simple
to Earn. Refer your friend to work with
Rockaway
and receive $500 for each referral.*
Applicants Information
Referee Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Your Information
This section is used for the referring employee information.
Referrer Name
(Required)
First
Last
Phone
(Required)
Consent
(Required)
I agree understand the rules and conditions of this referral program.
(Required)
- Aide must work for Rockaway in Nassau or Suffolk county for at least 50 hours for the referee to get paid for the applicant
- Aide must not already have applied with Rockaway Home Care or be working for Rockaway Home Care
- Initial application must be put through this form with the Referee information on the form.
- Aide must start working with in 3 months of completed application
- Aide must be referred by 9/1/2024
Email
This field is for validation purposes and should be left unchanged.
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How can we help you?
Please select one option
Signup For Home Care
Signup For CDPAP
Signup For NHTD
Signup for Private Pay
Start Working With Rockaway
Name
First
Last
Email
Phone
Select Location(s)
(Required)
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Rockland
Suffolk County
Nassau County
Westchester
Are You?
(Required)
A licensed Home Health Aide (HHA)
A licensed Personal Care Aid (PCA)
CDPAP - I have a family member I want to care for
Looking for training
Are You The?
(Required)
Patient
Family
Friend
Other
Does the patient have Medicaid?
(Required)
Yes
No
I am not sure
What Is Your Medicaid Number?
Medicaid numbers should be in AB12345C format.
One MUST have MEDICAID to enroll in the CDPAP, NHTD And Homecare programs. Medicare is NOT enough
Would you like help applying or determining eligibility?
(Required)
Yes
No
Are you looking to pay privately or with long term care insurance?
(Required)
Yes
No
Again, one is NOT eligible to enroll in the CDPAP, NHTD or Homecare programs WITHOUT MEDICAID
Consent
Yes, Rockaway can contact me via txt, email, or calls to provide more information
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.
How can we help you?
Please select one option
Signup For Home Care
Signup For CDPAP
Signup For NHTD
Signup for Private Pay
Start Working With Rockaway
Name
First
Last
Email
Phone
Select Location(s)
(Required)
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Rockland
Suffolk County
Nassau County
Westchester
Are You?
(Required)
A licensed Home Health Aide (HHA)
A licensed Personal Care Aid (PCA)
CDPAP - I have a family member I want to care for
Looking for training
Are You The?
(Required)
Patient
Family
Friend
Other
Does the patient have Medicaid?
(Required)
Yes
No
I am not sure
What Is Your Medicaid Number?
Medicaid numbers should be in AB12345C format.
One MUST have MEDICAID to enroll in the CDPAP, NHTD And Homecare programs. Medicare is NOT enough
Would you like help applying or determining eligibility?
(Required)
Yes
No
Are you looking to pay privately or with long term care insurance?
(Required)
Yes
No
Again, one is NOT eligible to enroll in the CDPAP, NHTD or Homecare programs WITHOUT MEDICAID
Consent
Yes, Rockaway can contact me via txt, email, or calls to provide more information
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
