Dear Applicant,

This application packet is intended for use in compiling an attendant registry list, and in no way guarantees employment. In order for you to be referred through this agency, it is important for you to read this thoroughly.

Please fill out the application completely. If you have any questions, they can be addressed during your interview.

The Employment History and Reference sections are very important and must include full names and current phone numbers. Work related or personal references are required (no relatives). If any reference returns a negative response, PIRS will not place your name on the registry, nor refer out. You will be notified if a problem arises.

Once all of your references have been checked (and turned out positive), your name will be included in our registry. We refer your name, phone number, and qualifications to employers with disabilities based on your application. According to the terms of the Attendant Contract, which you must sign to be considered for referral, approval of your application does not mean automatic referral. It is PIRS' discretion to refer attendants as they see fit.

Please be aware that prior to any employment, an extensive background investigation, including a criminal background check, may be required (at your expense), except in certain circumstances.

Thank you for taking the time to fill this out accurately and completely.

PIRS Staff

Fill out Personal Assistant Application.