Are you a current Home Care Attendant working for Granite State Independent Living and looking for additional hours? Let the GSIL Registry help you by submitting your information on the form below. If you are currently on the registry and your personal information, area of travel or availability has changed, please provide us with the correct information using the form below or contact us, so we have complete and updated information.

Please do not include any personal information about the current GSIL home care customers you are working with in the form below. We can use your name and location to determine that specific information or get more details in a follow-up communication. Thank you.

REGISTRY WAIVER: I understand that by proving Granite State Independent Living the following information I am allowing Granite State Independent Living to place my information on their registry for use by their consumers, their service coordinators and their recruitment coordinators. I understand the intent of this registry is to make available to consumers, service coordinators and recruitment coordinators of Granite State Independent Living, information of persons desiring to work as Home Care Attendants, and is not to be seen as an endorsement for employment. This GSIL registry and any information within it are for the sole use of Granite State Independent Living consumers, service coordinators and recruitment coordinators and contains information that may be privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited.

Date

Your Name

Email Address

Phone Number

Availability (days & hours)

Can you provide live-in services?
YesNo

Can you provide respite services?
YesNo

Are you insured to provide transportation services?
YesNo

Are you capable of lifting and moving another person?
YesNo

What towns are you available to work in?

Describe your experience.

Please list any restrictions.

Additional Details