info@inlandrc.org
1365 S. Waterman Ave., San Bernardino, CA, 92408, US
Applicant Name
Address
Please attach a copy of your identification, as well as your professional resume for review
Time Employed
Company Address
School Address
Dates Attended
Please attach 3 reference letters, must include contact information and be signed.
What type of Day Service are you Interested in Providing? (Check all that apply)
Have you ever been vendored by IRC or another regional center?
Please attach a copy of your most recent Quality Assurance Evaluation
Applicants applying for Day Services Orientation who are currently vendored providers for IRC or any regional center, must have services in good standing.
