Personal Care Attendant Registry: Application | Executive Office of Health and Human Services

Official State of Rhode Island website

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The Executive Office of Health and Human Services State of Rhode Island

Start:

Personal Care Attendant Registry Application

Title

First

Middle

Last

Suffix

Confirm Age

I certify that I am 18 years of age or older

Your PCA ID number (If you already have one)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Your Email Address

Your Phone Number

Best time for us to call you

How did you hear about the PCA opportunity?

List any allergies or special needs and other important information your prospective employer should know about you.

	Language, please select all in which you are fluent
English	English
Spanish	Spanish
Portuguese	Portuguese
Arabic	Arabic
Cape Verdean Creole	Cape Verdean Creole
Chinese	Chinese
French Creole	French Creole
Haitian	Haitian
Italian	Italian
Khmer	Khmer
Laotian	Laotian
Russian	Russian
Vietnamese	Vietnamese