Direct Support professional Application

Iowa Nursing And Rehab DSP Application

Submit your application with required documents. A copy will be sent to your email.

1) Applicant Information

First Name

Required

Middle Name

Required

Last Name

Required

Date of Birth

Required

Phone

Required

Valid email required

Street Address

Required

City

Required

State

Required

ZIP

Required

2) Position & Availability

Applying For

Required

Available Start Date

Required

Desired Wage ($/hr)

Available Shifts (select at least 1)

Days (6am–2pm) Evenings (2pm–10pm) Nights (10pm–6am) Weekends Holidays

Select at least one shift

3) Experience & Compliance

Years of HCBS/DSP Experience

Required

Valid Driver’s License?

Required

Reliable Transportation?

Required

Consent to background/abuse registry checks?

Required

Legally authorized to work in U.S.?

Required

Skills & Support Experience

4) Upload Documents

Resume (PDF/DOC)

Required

Government ID

Required

Certifications

5) Attestation & Signature

I certify all information is true and complete. I authorize Iowa Nursing And Rehab to verify submitted information.

Digital Signature (Full Legal Name)

Required

Signature Date

Required

IP Address (optional)