Consumer / Advocate


To receive a (FREE) copy of the Weekly Newsletter with current program developments or articles and information about available PCA Candidates, please send an Email to elitcher@consumerdirectedservices.com
With your Name and the phrase Newsletter Request

If you are a Consumer (an Independent Recipient of Home Care Services - a Person with a Disability, a Senior or a Consumer Advocate) and you are searching for a PCA Candidate, you can distribute an outline of your search criteria (FOR FREE) to the PCA Candidates and the other members of the Consumer Directed Services email database by COMPLETING AND SUBMITTING THE FOLLOWING FORM.

It is my hope that this system will prove useful in your search for the "right" employee but as an independent employer you must agree to take full responsibility for any personal injury or loss of property that may result from the action or inaction of your employee. In addition, Consumer Directed Services can not condone the use of this service to establish an employment relationship that does not provide equal employment opportunities to all prospective employees regardless of their age, race, creed, color, national origin, sex, disability, marital status, sexual orientation or affectional preference. Nor can Consumer Directed Services condone employment situations that ignore child labor or minimum wage regulations.

Note: (to move from field to field please use the "TAB" key)

Consumer Information:
Consumer's Name (For Consumer Directed Services Only) - Required

To preserve your privacy you can use an Alternative Name in this job offering.
Name

Neighborhood Name
City, Town or Borough
Available Transportation: Tramway . . . . Subway . . . . Bus . . . . Train. . . . Auto
Other Transportation - Describe

Phone ... Best Time

Consumer's E-mail - Required

Note: An E-Mail address is Required to permit Consumer Directed Services to add you to our data base
and to permit you to receive the weekly newsletter.
Do you authorize Consumer Directed Services to PUBLISH your E-mail address on the Internet?
Yes . . . .No

If you did not authorize the release of your Private E-mail,
you have the option to provide an Alternative E-mail
(such as a free GMAIL address that you can open for this purpose) in the following space..
Alternative E-mail

Consumer's Age:
Younger than 21 . . . .Between 21 and 30
Between 31 and 50 . . . .Between 51 and 70
Older than 70

Consumer's Gender: Female . . . .Male

Method of Providing the Employee's Salary and Benefits:
Home Care Agency . . . .Self Pay

Type of Candidates Requested:
Domestic / Homemaking
Personal Care / Home Health
Other Employees - Describe

Candidate's Experience:
Children . . . . Teens . . . . Young Adults . . . . Seniors
Paraplegia . . . . Quadriplegia . . . . Hemiplegia . . . . Amputation
Ventilators . . . . Wheelchairs . . . . Lifters . . . . Other Equipment
Mental Impairments/Alzheimer's Disease . . . . Visual/Auditory Impairments
Special Diets - Describe
Languages - List

Preferred Candidate Gender: Female . . . .Male

Candidate's Documentation:
Social Security Number . . . . Proof of Identity . . . . Recommendations

Proposed Schedule:
Daily Hours . . . . Days Per Week . . . . Start Time
- Describe

Proposed Salary:
Per Hour . . or . . Per Day . . or . . Per Week

Other Selection Criteria / Comments / Recommendations:

FINAL CONFIRMATION:
I am a Person with a Disability, a Senior or a Consumer Advocate searching for a PCA Candidate
Yes . . . .No


THANK YOU
FOR YOUR INTEREST IN
CONSUMER DIRECTED SERVICES

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CONSUMER DIRECTED SERVICES
Edward Litcher
540 Main Street, Suite B1314, Roosevelt Island, NY 10044
Phone: 718.233.3312
Fax: 718.233.3312

Email: elitcher@consumerdirectedservices.com