Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to obtain the application and open it in your chosen editor.
2. Begin by entering your name in the designated fields for the last name, first name, and middle initial. Ensure the information is accurate as it will be used for identification purposes.
3. Input your address, including street, city, state, and zip code. Double-check for accuracy, as this is required for correspondence.
4. Fill in your contact information, including home phone, secondary phone, and email address. Make sure to verify the format of the phone numbers.
5. Provide your previous experience in providing direct supervision and special services to individuals with developmental disabilities. Fill in the name of the company, the duration of employment, and the duties performed.
6. Continue to list any additional relevant experience in the same format as the previous step, including company name, dates of employment, and duties.
7. Complete the education section by listing your most recent schooling, including the school name, degree received, and graduation date.
8. Enter at least three professional references, ensuring that one is from a previous employer in the direct support professional field. Include their name, address, and telephone number.
9. Indicate your purpose for attending the orientation by checking the appropriate options and specifying any additional details as required.
10. Finish the application by reviewing all information provided. After confirming it is correct, print your name, sign, and date the application to validate it.
11. Finally, save changes, download or print the completed form, and share it as necessary according to submission guidelines.

Complete your application online today to take a step toward becoming a service provider.