The Collaborative NJ Interactive Map: Self-Directed Employee Form
This form is for Self-Directed Employees that wish to post or update their availability on The Interactive Map.
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Select one of the following
This is my first time filling out this form/I would like to be listed on the map
I have previously filled out this form, but I would like to update my listing
What is your name?
How many years of experience do you have as a Direct Support Professional or Self-Directed Employee?
Your Phone Number
Your Days/ Hours of Availability to work:
Your Location (City, ST):
Your Zip code/County:
List the towns you are interested in working.
The fiscal intermediaries you currently enrolled with:
Public Partnerships Group (PPL)
Both PPL and Easterseals
Do you have any of the following certifications?
Have you passed the NJ state requirements for SDEs within the last 6 months?
Are you able to drive the person you would support using your own vehicle?
How did you learn about The Interactive Map?
A copy of your responses will be emailed to the address you provided.
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