Alaska administrator designee form 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Individual' in the designated field. This is crucial for identifying the applicant.
3. Select the appropriate role for this individual by checking one of the boxes: Administrator, Resident Manager, or Designee.
4. Fill in the 'Name of Assisted Living Home' and its phone number to provide context about where this individual will be working.
5. Input the 'Date of Birth' in MM/DD/YYYY format, followed by any applicable driver's license number.
6. Complete both physical and mailing addresses accurately, ensuring all fields are filled out correctly.
7. List three character references who are not related to you, including their names and contact information.
8. Provide two employment references as required, ensuring they meet the same criteria as character references.
9. Attach necessary documentation that proves eligibility based on specified criteria for administrators serving different resident capacities.
10. Finally, review all entered information for accuracy before signing and dating your application at the bottom of the form.

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