CDPAP Personal Assistant Application

PA Application cover page CDPAP Personal Assistant Application All forms and requested information must be completed before employment can be authorized. Authorization must come from South Shore Home Health Services, Inc. Below is a directory assistance to help you with this process. Please call (631) 567-6555 or 1-800-404-9060. Application completion requirements/questions Nora Duran Ext. 301 Program Questions Jackie Datkun ext. 316 Benefits/health insurance Jayne Rizzo Payroll Ext. 326 Ext. 322 CDPAP hiring checklist South Shore Home Health Services, Inc. Consumer Hiring Requirements Complete top portion only Personal Assistant Name:_____ Date: _____ Consumer s Name:_____ New: Yes No Consumer s Address_____ Consumer s County _____ ie: Suffolk, Nassau or Westchester Office Use Only Hiring Requirements Application Form W-4 Form Guide to the CDPAP acknowledgement Health Insurance waiver DOL Acknowledgement of wage rate/payday Transportation Waiver Insurance Car

Form W-4 (2013) Purpose. Complete Form W-4 so that your working spouse or more than one job, figure employer can withhold the correct federal income total number of allowances you are entitled tax from your pay. Consider completing a new Head of household.Form

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