Get Dr0171 Isp Application Pdf

The Dr0171 Individual Service Provider (ISP) Application PDF is a crucial document for individuals seeking to provide services under the Department of Rehabilitation in California. This guide provides clear and comprehensive instructions on how to effectively complete the application online.

Follow the steps to complete your application with ease.

1. Click the ‘Get Form’ button to download the application and open it in your preferred PDF editor.
2. Begin filling out the form by entering your name in the designated field. Be sure to provide your complete legal name.
3. Enter the last four digits of your Social Security number in the respective field. This information helps in identifying your application.
4. Fill in your mailing address only if it differs from your street address. Ensure all fields are completed accurately.
5. Provide your contact information, including your phone number, driver's license or ID number, and email address. Make sure these details are current for effective communication.
6. If applicable, include details about your auto insurance, including the carrier and policy number. Also, specify the expiration date if you intend to provide driving services.
7. List three professional references, including their names, addresses, and phone numbers as required. Ensure that these individuals can speak about your qualifications.
8. Indicate whether you have applied to provide services in other districts by selecting yes or no, and if yes, list the districts.
9. Answer the question regarding if you are a family member or close friend of a DOR applicant or consumer, providing the person's name if applicable.
10. Disclose any past felony or misdemeanor convictions, providing an explanation if applicable. Transparency is essential at this stage.
11. Outline the services you wish to provide as an Individual Service Provider, specifying the service category and level of service along with any additional comments.
12. Mark your available days and times for services by checking the appropriate boxes for mornings, afternoons, and evenings.
13. Complete the education section by listing all relevant diplomas, degrees, colleges, and trade schools attended along with their respective dates.
14. Fill out your employment experience, including prior employers and duties. You can attach a resume for additional detail.
15. Review your application carefully for accuracy. Sign and date the form to validate that the information provided is correct.
16. Once completed, save your changes. You can download, print, or share the form as needed.

Complete your Dr0171 ISP application online today to facilitate your application process.