Public authority san bernardino 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by clearly printing your CURRENT contact information. Fill in your Last Name, Middle Initial, and First Name. Ensure you provide the Last 4 Digits of your SS#.
3. Indicate if you have moved by checking 'Yes' or 'No'. If 'Yes', list the cities you are willing to work within a 20-mile radius from your home.
4. Complete your Home Address and Mailing Address sections, including Apt #, City, and Zip Code for both addresses.
5. Provide your Phone Number (Home and Cell) and Email Address where clients can reach you.
6. If applicable, indicate that you are no longer working with clients by selecting one of the options provided in Question #2. If selected, sign, date, and return the form here.
7. If you are currently working for a client, answer Question #3 by stating how many clients you have and providing their names.
8. In Question #4, specify your available days and times for work. Use clear formatting similar to the example provided.
9. Finally, ensure to sign and date the form before returning it.

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