Follow the steps to complete the questionnaire successfully.

1. Press the ‘Get Form’ button to access the questionnaire and open it in your preferred online document editor.
2. In the first field, enter the name of the assisted living home with which you will be associated. Ensure accuracy as this identifies your affiliation.
3. Select the role you are proposing for yourself by marking the appropriate option: Administrator, Designee, or Resident Manager.
4. Provide the full name of the individual, which refers to yourself, in the designated field.
5. Input your date of birth in the format MM/DD/YYYY. This is necessary for identification purposes.
6. If you have a driver's license, include the driver's license number in the provided space; otherwise, you may skip this field.
7. Fill out your physical address, including street, city, state, and zip code, ensuring all information is complete and correct.
8. Provide your mailing address if it differs from your physical address. Similar to step 7, include the street, city, state, and zip code.
9. Enter your email address, ensuring it is a valid and accessible email, as this may be used for correspondence.
10. List your primary phone number and, if applicable, include an alternative phone number to facilitate communication.
11. You must submit detailed documentation demonstrating that you meet at least one of the qualification criteria. Ensure you select all that apply from the provided options and attach appropriate documentation that outlines your experience.
12. Attach additional required documentation, including a government-issued ID, proof of freedom from active pulmonary tuberculosis, current CPR and first aid certifications, character references, and employer references.
13. Review all entered information for accuracy and completeness. Once satisfied, proceed to save your changes.
14. Finally, you may choose to download, print, or share the form as necessary based on your submission requirements.

Complete the AK Administrator/Designee/Resident Manager Designation Questionnaire online today to take the next step in your assisted living career.