Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the consumer name as requested at the top of the form. Ensure that the name is spelled correctly to avoid any processing errors.
3. Fill in the employee information section. Start with your first name, followed by your middle name (if applicable), and last name. Provide your physical address details, including street address, apartment or unit number (if any), city, state, and zip code.
4. If your mailing address differs from your physical address, complete the mailing address section with the same details as requested.
5. Input your home phone number and cell phone number. Indicate whether you consent to receive text messages from CDCN regarding work activities by selecting ‘Yes’ or ‘No’.
6. Enter your email address, date of birth, and social security number while ensuring that the date of birth indicates you are over 18 years old. Lastly, mention your place of birth (state).
7. In the emergency contact section, provide the name, phone number, and relationship of your emergency contact who can be reached if necessary.
8. Address the physical capacity question by affirming your ability to perform the required physical tasks by selecting ‘Yes’ or ‘No’. If necessary, use the comments section to provide explanations.
9. For the professional standards and licensing questions, honestly reply to whether you have had any professional license revoked or had any moving violations or motor vehicle accidents in the last three years. Provide explanations where applicable.
10. Indicate if you have previously worked for Consumer Direct Care Network Nevada by selecting ‘Yes’ or ‘No’. If you have any aliases or previous names, list them in the designated section.
11. Finally, make your choice regarding the Candidate List. Indicate whether you wish to be included on the Candidate List to avail additional work opportunities.
12. Review all provided information for accuracy and completeness. Once satisfied, save your changes, and then download, print, or share the completed form as needed.

Begin filling out the NV Consumer Direct Care Network Employee Data Form online today!