Get Ca Irc New Residential Service Provider Orientation Application 2016-2025

This guide provides clear instructions on how to complete the CA IRC New Residential Service Provider Orientation Application online. Following these steps will help ensure that all necessary information is accurately submitted.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the application form and open it in your preferred online editor.
2. Fill in your personal information. Enter your last name, first name, middle initial, address, city, state, and zip code accordingly. Make sure to include your home phone number, any secondary phone number, and your email address.
3. Provide your experience in supervising and delivering special services to individuals with developmental disabilities. Include the company name, employment dates, the street address, city, state, and zip code of your past employer. Note the phone number of the employer and the vendoring regional center.
4. In the experience section, describe your duties performed at each position you held in detail for all listed companies.
5. List your educational background, ensuring you start with the most recent. Include the school name, address, degree received, and date received for up to three institutions.
6. Identify at least three professional references. For each reference, provide their name, address, and telephone number. Ensure at least one reference is from a previous employer related to direct support professional experience.
7. Explain your purpose for attending the orientation. Select appropriate options regarding your intentions, such as becoming an administrator, opening a new facility, or any other reason. Provide details like the type of facility you are interested in and the city or cities you are considering.
8. Indicate if you have ever been vendored by another regional center. If so, include the name of the center, vendor number, and the most recent quality assurance evaluation.
9. State whether you have previously attended the NRSPO. If applicable, provide the date of your last attendance.
10. Sign and date the application. Your signature confirms that all information is accurate and grants permission for the Inland Regional Center to contact your listed references.
11. Prepare any required attachments. Include proof of direct care staff experience, community care licensing orientation certificate, administrator's certificate, DSP certificate, professional resume, and three professional letters of reference.
12. Submit your completed application and attachments via mail or email to the Inland Regional Center. Ensure that you send it to the correct address provided.

Complete your CA IRC New Residential Service Provider Orientation Application online today and take the first step towards serving individuals in need.