If you would like to become a Direct Care Provider for your loved one, please:
1.) Fill out the linked forms
2.) Give us a call with your questions
3.) When you have completed all the forms, send them our way!
You can upload the completed forms here or
email them to: firstname.lastname@example.org
Please note: The forms that are fillable can be saved by using the print function.
Simply choose "Print," "Destination," and "Save as pdf"
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BEFORE WE GET STARTED
To become an Arizona State Licensed Direct Service Provider,
please know that all Arizona State DSP employees are required to use the state-mandated automated clocking in/out system,
AUTO-VISIT, with the use of a cell phone or tablet. The required app can be obtained on your device's app store.
Get started on becoming a Direct Service Provider, by submitting the following documentation:
Front & Back of Valid Driver's License
Front of your Social Security Card
Front & Back of Valid Fingerprint Clearance Card (Must be obtained prior to hiring)
Front & Back of Valid CPR/First Aid Card (Must be obtained, prior to hiring - cost covered by OTRBG)
STEP 1 ~ GETTING STARTED
Please fill out the application completely and list at least 3 months of relevant care/support experience.
(Must be 18+ old to apply)
Please submit 3 separate references - 2 business & 1 Personal
REFERENCE CHECK - 3 copies
(2 Business & 1 Personal)
AZ DES DIRECT SERVICE
STEP 2 ~ NOTARIZED BACKGROUND CHECKS
OTRBG can notarize these forms for you.
If you choose this option, you may fill the form out, but please DO NOT sign until we meet in person.
For the Criminal History Self-Disclosure, each box must be checked individually.
ADULT PROTECTIVE SERVICES (APS) AFFIDAVIT
CRIMINAL HISTORY SELF DISCLOSURE AFFIDAVIT
STEP 3 ~ AGREEMENTS, AUTHORIZATIONS, AND PERMISSIONS... OH MY!
Please fill out the employee agreement of standards and permission forms.
Please fill out and sign the Direct Deposit form to obtain your paycheck.
For your protection, it is highly recommended that care providers obtain the Hepatitis B immunization.
This is optional and OTRBG offers this vaccine free of charge.
If you decline to receive this vaccine, please fill out the Hepatitis B Declination form.
If you change your mind, you can receive this vaccination at any time during your employment by letting your supervisor know.
AGREEMENT OF STANDARDS
STATE DUPLICATE BILLING
AHCCCS & DDREPORTS
NEARLY DONE! - DRIVER?
IF you plan on providing transportation for your loved one, for medical or recreational purposes while working,
please fill out the driver form, permission to obtain DMV record, and please submit the following:
Copy of current vehicle insurance
Copy of current vehicle registration
** Please Note**
Per insurance requirements,
OTRBG is required to do a vehicle inspection on any vehicle being used to transport clients while working.
Please review the Supervisor Inspection Form used when conducting an inspection
and make any necessary repairs to your vehicle prior to inspection.
IF you DO NOT plan on providing transportation for your loved one, for medical or recreational purposes while working,
please fill out the NON-DRIVER DECLINATION FORM below:
***IF AT ANY TIME, YOU CHANGE YOUR MIND ABOUT BECOMING A DRIVER OR DISCONTINUING DRIVING, YOU ARE REQUIRED TO FILL OUT NEW DOCUMENTATION INDICATING SUCH.
NON-DRIVER DECLINATION FORM
After being hired, you will be trained by OTRBG in the following certifications:
Article 9 (Prior to providing care)
Arizona Direct Care Worker (DCW) Fundamentals & Developmental Disabilities Training (Within 90 days of hire date)