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Step One

Placer County In-Home Supportive Services Public Authority Registry Application
Must be 18 years old to apply.
Instructions
If you already have a recipient you want to work for, this is NOT the process to become an IHSS provider. Call 530-889-7115 and ask for the enrollment department. If you are seeking a recipient, please complete all areas of the application. Please only apply once. If you feel you made errors or you would like to check the status of your application, please call or email [email protected] ***We are not currently accepting applications for the Tahoe region.***
First Name
Last Name
Address
City
State
Zip Code
Mailing Address (if different from above)
Cell Phone Number
Home Phone Number
Email Address
Select One
1. Male
1. Female
Are you 18 years or older?
1. Yes
1. No DO NOT CONTINUE - MUST BE 18 TO APPLY
Continue

Have you had previous experience providing In-Home care?
1. Yes
1. No
If you answered yes to the previous question, how many years experience?
Check all that apply
Are you currently working as an IHSS Provider
1. Yes
1. No
Certificates or Licenses you possess
1. CPR
2. First Aid
1. C.N.A.
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