Personal Assistant/Individual Provider Application

RAMP empowers people with disabilities to realize that there is no limit to what they can do. With this in mind, RAMP assists people with disabilities in obtaining the skills to hire and maintain Personal Assistants/Individual Providers (PA/IP).

PA/IPs assist with household tasks, personal care, appointment scheduling, and money management and, with permission of a doctor, certain health care procedures. PA/IPs are selected, employed and supervised by individual consumers.

RAMP maintains a list of Personal Assistants/Individual Providers and provides that list to the consumers we serve.

IMPORTANT – PLEASE READ THE FOLLOWING:

  • THIS IS NOT AN APPLICATION FOR EMPLOYMENT
  • RAMP DOES NOT EMPLOY PERSONAL ASSISTANTS/INDIVIDUAL PROVIDERS
  • ALL DECISIONS TO HIRE OR TERMINATE THE SERVICES OF A PERSONAL ASSISTANT/INDIVIDUAL PROVIDER ARE MADE BY THE CONSUMER AND NOT THE RESPONSIBILITY OF RAMP
  • WAGES FOR PERSONAL ASSISTANTS/INDIVIDUAL PROVIDERS ARE PAID THROUGH THE DIVISION OF REHABILITATION SERVICES (DRS) AND/OR THE INDIVIDUAL REQUIRING ASSISTANCE, NOT RAMP

Becoming a Personal Assistant/Individual Provider is a THREE STEP process:

    1. Complete the Personal Information Form online or in person
    2. AFTER you submit your online application, go back to the page to pay for the background check online via PayPal or in person ($20.00 non refundable fee online (includes processing convenience fee), $15.00 in person)
    3. Attend a mandatory orientation. In order to attend the orientation it is required that you bring a valid driver’s license and social security card with you to the orientation.

YOU WILL BE CONTACTED BY AN EMPLOYEE WITH RAMP TO SCHEDULE ATTENDANCE AT THE ORIENTATION AT THE RAMP OFFICE OR TO ADVISE YOU OF ANY ADVERSE FINDINGS ON YOUR BACKGROUND CHECK THAT MAY PRECLUDE YOUR ABILITY TO BE INCLUDED ON RAMP’S PA/IP REFERRAL LIST.

I understand that my application will not be accepted until I pay the background check fee.
YESNO


Please be aware that this is NOT an application for employment. You must fill out this form if you would like to have your name placed on our PA/IP Referral List which is shared with consumers who hire and maintain PA/IP’s. Wages for Personal Assistants/Individual Providers are paid through the Division of Rehabilitation Services (DRS) and/or the individual requiring assistance.

A copy of your driver’s license/state I.D., copy of your Social Security card and filling out the below information is REQUIRED. You must also attend a mandatory orientation session before your name is added to the Statewide PA/IP Referral List. (Information required, for RAMP staff to complete a background check, and orientation eligibility)

Personal Information



My gender is: (choose all that apply)
MaleFemaleBothOtherNot Specified

Date of Birth

Social Security


Previous address if less than 2 years at current address:

Have you ever been convicted of a criminal violation?
YESNO

RELEASE OF INFORMATION WAIVER


By submitting this form online, I authorize RAMP to perform a criminal background check on me, and to release the information on this form and the results of the criminal background check to consumers who are looking for a PA/IP so that they may consider hiring me. I understand that RAMP publishes a link to their PA/IP Referral List on the RAMP website and that my contact information will be available on there if my name is added to the Referral List. I understand that completing the program requirements does not mean that I will be hired as a PA/IP by a consumer. I understand that if I am hired as a PA/IP by a program participant that I will NOT be an employee of RAMP. I understand that yelling, cursing or being disrespectful to RAMP staff or consumers will get me removed from the RAMP PA/IP Referral List.