PA Registry Update Ready to update your PA Registry? Just fill in the form and submit! PA Registry Update Monthly PA Registry Update Date Your Name*Contact information changes*Name, address, phone, email. If no changes to your contact information, please write, "No changes".Current EmployerName and hours of the consumer you are working for.Week Days available to work* Monday Tuesday Wednesday Thursday Friday Weekend Days available to work* Saturday Sunday Not available for any weekend work Shift time available to workAM (6am till noon)PM (after noon til midnight)Overnight (midnight to 6am)Any time AM or PMAny time/any shiftThese are approximate time periods and are not specific times you would be working or are obligated to work, it is an indicator to a span of time you are available.Availabilty Special/Special NotesThis area is to be completed only if days or time vary for your availability or there is other specialized information you wish for us to have regarding your availabilityRegistry Information Yes, to remaining on Registry, but not available at this time to work I am available to work, but please have potential consumer call me with opportunities I no longer want to be on the Registry and realize that I will be removed and no longer receive potential employment opportunities Select either of these areas in regards to varying degrees of availability. Please contact mePhoneEmailPlease let us know if you have questions and would like us to contact you.Thank youYour information will be updated and remain confidential to only members of the NICIL Home Service Program. Just a reminder you need to update monthly either here, on our website, or via phone, email, or fax. Without a monthly update, you will be removed from the NICIL Registry.Privacy* By using this form you agree with the storage and handling of your data by this website.