Missouri Self-Directed Supports NEW EMPLOYEE SAMPLE PACKET

Transcription

1 Missouri Self-Directed Supports NEW EMPLOYEE SAMPLE PACKET Working on a New Employee Application is a team effort between the prospective Employee and the Employer and/or their Designated Representative. Errors made throughout the New Employee Packet are the most common reason for a delay in being able to start employment. The New Employee Sample Packet intends to assist a prospective Employee and the Employer and/or Designated Representative complete a New Employee Packet. The New Employee Sample Packet can be used together with other new employee guides on our program website: In the following pages, you will find a sample of how to complete each required page of the New Employee packet. Please keep in mind, the sample packet is just an example and each page may be completed differently for each employee. Take a look at each explanation to see how to fill out each section. Employee Application Page Employee Application Page Family Care Safety Registry... 9 USCIS I-9 Form Federal W Missouri W Missouri W-4A (optional) Post-Employment Verification Form In addition to Public Partnerships application, each new employee is required to provide supplemental documents including: 1. A copy of the document that verifies the education requirement indicated on page 4 of the employee application 2. A copy of a valid Abuse and Neglect Training Certificate 3. Copies of the documentation provided on page 2 of the UCSIS I-9 Form Page 2 If your employer requires training, the employee must also provide valid proof of training, like: 1. CPR Training 2. First Aid Training 3. Medication Administration Training 4. Positive Behavior Supports 5. Crisis Management Training If you need additional assistance with completing a New Employee Packet, please see our other New Employee Guides on our program website. They are also referenced throughout the following pages. We look forward to working with you! DMH-DD: New Employee Sample Packet Version 1.0 Page 1 of 1

2 1. Type of Application: Please indicate if you are applying to be a Personal Assistant or a Community Specialist a 4b 4c 4d 2. Program Qualifications: Please answer each of these questions. If you answer Yes to any question, you are not qualified to provide services in MO SDS. 3. Individual Information: Please list the Individual who will be receiving services First Name in the first cell and Last Name in the second cell 4. Employee Name: Please list the First Name, Middle Initial (if applicable), and Last Name of the Employee a. Date of Birth: Please list the employee s Date of Birth 4b. Social Security Number: Please list the employee s Social Security Number 4c. Gender: Please check the box that indicates the gender of the employee 4d. Relationship to Individual: Please check only one box to indicate the best description of the relationship the employee has to the individual 5. Physical Address: Please list the employee s physical address including street, city, state, zip code, and county Page 2 of 15

3 6 7a 7b Mailing Address: Please complete this only if the employee has a mailing address that is different from the physical address on page 1 7a. Phone Number: Please list the primary and, if applicable, the employee s alternate phone number 7b. Address: Please list the employee s . This is required, as Public Partnerships sends training notifications and important reminders electronically 8. Emergency Contact Information: This is optional. If the employee would like to provide an emergency contact, please list their name and phone number 9. Authorization to Withhold City Payroll Tax: Please indicate whether the employee lives in Kansas City or St. Louis or the employer/individual resides in Kansas City or St. Louis Page 3 of 15

4 10a. Type of Personal Assistant: Please indicate the type of Personal Assistant. If the employee is applying to be a Community Specialist, please skip 10a-11e and complete 12a- 12b 10a 10b 11a 11b 11c 11d 11e 12a 12b 10b. Type of Education Requirement: Please indicate what type of proof of education the employee has. Please include a copy the education document 11a-e. PA Training Requirements: Please indicate if any of the trainings are required training. If it is not, please indicating why it is exempt by selecting A or B CPR is valid for 2 years. First Aid is valid for 2 years. Medication Administration is valid for 2 years Crisis Management is valid for 1 year Positive Behavior is a one-time training Abuse and Neglect is valid for 2 years Please include a copy of any required trainings when sending the application to Public Partnerships 12a. Community Specialist Training Requirement: Please answer the question regarding your relationship status 12b. Community Specialist Training Requirement: Please indicate what type of education the employee has. Please remember to include a copy of the proof of education and experience. Page 4 of 15

5 Difficulty of Care: Completing this form is optional. Please review the description of the Difficulty of Care Federal Income Tax Exclusion. More information about the Exclusion by clicking here. Please have the employee review Step 1, 2 and 3 to determine if the employee is eligible. If you do not qualify, please send in blank. Page 5 of 15

6 Relationship Questionnaire: Please respond to questions based on your relationship to the employer of record. The employer of record may be the individual receiving services, or it may be the individual s designated representative. These questions help determine the billable rate for the services the employee provides and is required. Page 6 of 15

7 Service and Rate Information: Please check the box next to the corresponding service code that the employee will be billing under. Please also list the desired rate of pay for the employee. 16a. Payment Type: Please indicate how the employee would like to be paid. Public Partnerships is Go Green and does not issue paper checks unless we are establishing a new payment account. 16a 16b 16c 16b. Account Type: Please indicate what type of account the payment will be issued to. If the employee is selecting a Payroll Card, please check the box next to ADP ALINE Payroll Card. 16c. Account Information: If the employee is electing to receive payment via Direct Deposit, please complete this section. Public Partnerships requires the banking institution, the routing number and the account number. Page 7 of 15

8 17a. Employer/Designated Representative: Please print the name of the Employer of Record or the Designated Representative. The name listed on this line needs to match the signature. 17b. Employer/Designated Representative Signature: Please have the Employer of Record or the Designated Representative sign and date the form. By signing this form, you are agreeing to the attestation in bold. 17a 17b 18a. Employee Signature: Please have the employee sign and date the form. By signing this form, you are agreeing to the attestation in bold. 18a Please read all the entire employment agreement before signing this form. You can find a standalone version of the agreement on our program page or by clicking here. Page 8 of 15

9 19. Employer Information: Please complete the requested information regarding the employer. 20. Employee Signature: Please have the employee sign and date the form. By signing the form, you are authorizing Public Partnerships to register and or request the required background check from the Family Care Safety Registry (FCSR). 19 For more information about the FCSR, click here. 20 Page 9 of 15

10 21a. Employee Information: Please have the employee complete this section. All cells are required to be completed 21a 21b a 21b. Employee Attestation: Please check the box that matches your citizenship status 23. Employee Signature: Please have the employee sign and date attesting that the information in 21a-21b is correct. Please ensure it is the date of signature, not the date of birth 24. Preparer and/or Translator Certification: If the employee used a translator or preparer to complete page 1, please mark the box and complete 24a 24a. If a preparer or translator was used to complete page 1, please have them sign and date and complete the information request For more guidance on completing the I-9, visit our program website or click here Page 10 of 15

11 Employee Info from Section 1: Please complete this section based on what the employee indicated on page 1 of the I Identity and Employment Authorization: Please complete this section based on the documents provided to verify the employee s employment eligibility. See page 3 of the I-9 for acceptable identity and employment documents. 27. Employee s First Day of Employment: Please write the date the form is being completed. While the employee is not eligible to begin working on this date, this is the date that the employment process has begun for the employee. 28. Employer Verification: Please have the employer or authorized designated representative sign and date and complete the requested information. For more guidance on completing the I-9, visit our program website or click here Page 11 of 15

12 29. Filing Status: Please have the employee mark their federal income tax status 30. Withholdings: Please complete the allowances section. If the employee is exempt, please indicate so in field 7. Please note, the employee cannot be exempt and have allowances. 31. Employee Signature: Please have the employee sign and date the form. 29 If this form is not completed correctly, Public Partnerships will default the employee s filing status to Single and their allowances to 0, until the form is completed Page 12 of 15

13 Filing Status: Please have the employee mark their Missouri state income tax status 33. Withholdings: Please complete the allowances section. If the employee is exempt, please indicate so in field 7. Please note, the employee cannot be exempt and have allowances. 34. Employee Signature: Please have the employee sign and date the form. Page 13 of 15

14 Only complete this form if the employee lives outside of the state of Missouri. 35. Employee Information: Please have the employee who lives outside of the state provide the information in this section 36. Employee Proportion of Services: Please estimate the proportion of service you will be performing in the state of Missouri 37. Employee Signature: Please have the employee sign and date this form and write their printed name Page 14 of 15

15 This form needs to be completed and returned within 30 days of the employee s Good to Go date. 38. Employer/Designated Representative Signature: Please have the Employer of Record or the Designated Representative sign and date the form. By signing this form, you are acknowledging the above 39. Employee Signature: Please have the employee sign and date the form. By signing this form, you are acknowledging the above Page 15 of 15