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Public authority san bernardino 2026
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- Click ‘Get Form’ to open it in the editor.
- 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#.
- 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.
- Complete your Home Address and Mailing Address sections, including Apt #, City, and Zip Code for both addresses.
- Provide your Phone Number (Home and Cell) and Email Address where clients can reach you.
- 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.
- If you are currently working for a client, answer Question #3 by stating how many clients you have and providing their names.
- In Question #4, specify your available days and times for work. Use clear formatting similar to the example provided.
- Finally, ensure to sign and date the form before returning it.
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