Employee Orientation

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Step 1 of 11

Employee Checklist

Employee Name:*

First Name Middle Name Last Name

Click on the link below to view the Employee Handbook-2025
2025 Employee Handbook-DK.docx

ORIENTATION CHECKLIST

The following topics are included in our Employee Manual & presented in New Hire Orientation.

Welcome (Mission, Goals, Philosophy)
Policies & Procedures
Employment
Relationship
Workplace Safety
Workplace Guidelines &
Expectations
Employee Benefits
Handouts/Forms

The following Forms must be read and acknowledged by signature for employment.

Orientation Checklist
Handbook Acknowledgement/Receipt
Acknowledgement of Job Description/Rates
Employee Commitment to Proving Services and Job Responsibilities
TB Risk Assessment
Hep B Waiver/Request
Employee Contact
Health Screening

The following Training MUST be completed PRIOR to Case Assignment and Employment.

Personal Care Assistant (PCA) Curriculum Courses/Skills
Acquired Brain Injury Basis (ABI) Provider Directed
Recovery Aide (RA) Mental Health Waiver Class Provider Directed
Sexual Harassment (2-hour CHRO Course)
CT Elder Abuse
Ethics & Boundaries
Timesheet/Clock in-out/Incident Reporting

I acknowledge that I was given and read the Employee Handbook and the Handouts as Attachments in the Packet.

Employee Benefits
Training/Safety Packet
Emergency Preparedness
PFMLA
Elder Abuse
Sexual Harassment
Sandata/Santrax (Clocking In/Out)

I have reviewed the checklist above and have had the opportunity to ask questions regarding the Employee Manual and New Hire Orientation. I understand and agree to the information presented to me and will comply with the policies and procedures of Discovering Kindness In Home Services LLC and any changes or updates for employment at Discovering Kindness In Home Services LLC. I further understand that if I violate any policy and/or procedure I will be subject to disciplinary action which may include termination of employment or other repercussions.

Signature*

Date*

MM slash DD slash YYYY

Employee Acknowledgement of Policies/Procedures

Employee Name:*

First Name Middle Name Last Name

EMPLOYMENT ACKNOWLEDGEMENT & RECEIPT OF HANDBOOK

I understand and agree that nothing in the Employee Handbook creates, or is intended to create, a promise, contract or representation of continued employment and that employment at DISCOVERING KINDESS IN HOME SERICES is employment at will, which may be terminated at the will of either DISCOVERING KINDNESS IN HOME SERVICES or myself.

Furthermore, I acknowledge that this handbook is neither a contract of employment nor a legal document. I understand and agree that employment and compensation may be terminated with or without cause at any time by DISCOVERING KINDNESS IN HOME SERVICES or myself.

Initial Acknowledgement

Confidentiality: I understand that I am bound by ethical and legal codes to protect the confidentiality and privacy (either verbal, in writing, electronically, photos, videos & recordings) of our clients, co-workers and others associated with Discovering Kindness In Home Services and to protect and maintain the confidentiality of all information learned about, but not limited to clients, their family members and acquaintances in the course of providing services to them and/or information learned and/or acquired during my third-party agreement with Discovering Kindness In Home Services.

Initial Acknowledgement

Worker’s Compensation: I understand that in the event of a work-related injury or death, I am covered by my agency’s Worker’s Compensation Plan and must report incidents immediately or earliest time but within 24 hours.

Initial Acknowledgement

Electronic Time Keeping Procedures: (Santrax/Sandata EVV or other): It is mandatory that all employees clock in/out for each shift using Santrax EVV Systema and/or Generations (and/or TimeTrax for administrative staff) to verify time, services, individual and location. My paid hours will reflect my actual electronic clock in/out time. I understand that the falsification of documents, particularly those pertaining to the submission of visit notes/times where in fact no visit was made or failure to report accurate times, is considered fraud and is subject to disciplinary action or termination and civil and/or criminal prosecution per state and federal laws.

Initial Acknowledgement

Photos, Videos & Audio Recordings: Discovering Kindness In Home Services holds a zero-tolerance for the misuse of photos, videos and audio recordings of any of its clients, employees, visitors and other associated with Discovering Kindness In Home Services, other than for the purpose or treatment and reporting. Posting and/or sending of any form of media on social media platforms are strictly forbidden and will be subject to immediate termination and subject to state and federal laws as applicable.

Initial Acknowledgement

Universal Precautions – Covid-19: Follow CDC guidelines at all times including wearing a facemask/face covering while working/being with my client, handwashing/hand sanitizer procedures, social distancing guidelines, stay home if you are sick, cover your cough/sneezes with tissue/sleeve, wear gloves, and disinfect touch areas often. Adhere to COVID-19 policies, testing and reporting.

Initial Acknowledgement

Dress Code: Clothing shall be clean, neat and well maintained. Direct care personnel will wear scrubs unless otherwise directed. Clothing shall be appropriate and modest and avoid any symbols, logos, graphics that could potentially create conflict or offense. Shoes should be closed toed for safety. No flip-flops.

Initial Acknowledgement

Sexual Harassment Prevention Commitment: Harassment in any form, sexual, hostile environment and bullying is prohibited and have severe consequences. I am committed to supporting a safe environment and will report actions and behaviors that violate the policy and/or endanger individuals.

Initial Acknowledgement

Cell Phone Use and Personal Business: The use of cell phones while working is restricted to work related conversations and personal emergencies. Excessive use or complaints of use may lead to termination. Hands free cell use ONLY when driving vehicles (no phone in any hand) while driving. Violation may lead to termination and penalty of DMV laws.

Initial Acknowledgement

Training & Skill Competence: A continuous training program is necessary to maintain and/or improve overall effective, efficient, professional, and competent services to our clients. I will be required to maintain all the necessary training for my position(s) while working with Discovering Kindness In Home Services and its clients.

Initial Acknowledgement

Employment at Will:

Employment at DISCOVERING KINDNESS IN HOME SERVICES is an at-will employer. This means that either the employee or the company may terminate the employment relationship at any time, for any reason, with or without notice.

Initial Acknowledgement

Incident Reporting:

All incidents need to be reported immediately. The form must be completed or ALL unusual occurrences involving employees, clients or family and completed within 24 hours of the incident or sooner. An unusual occurrence is defined as any occurrence involving an employee, client or family member which is not consistent with regular routine, regardless of whether or not there was a apparent injury or other damage.

Instances of reporting immediately to your supervisor include but not limited to … change in client behavior, change in physical condition, any falls, cuts, bruising, refusal to take medication, any 911 Emergency calls, inappropriate behavior by the client, employee, or family member or other.

Initial Acknowledgement

Progressive Discipline:

DISCOVERING KINDNESS IN HOME SERVICES supports the use of progressive discipline to address issues such as poor work performance or misconduct. Our progressive discipline policy is designed to provide a corrective action process to improve and prevent a recurrence of undesirable behavior and/or performance issues. Our progressive discipline policy has been designed consistent with our organizational values. HR best practices and employment laws.

Initial Acknowledgement

Damage/Loss/Theft Acknowledgement: DISCOVERING KINDNESS IN HOME SERVICES holds a zero-tolerance policy for theft, damage and dishonesty. Any investigation leading to the confirmation of theft, damage or dishonest of any employee will result in the immediate termination of that employee. The policy creates no obligation on the part of DISCOVERING KINDNESS IN HOME SERVICES to reimburse any individual or entity for damages or theft of property.

Under no circumstance should the Employee admit liability or make offers of reimbursement on behalf of DISCOVERING KINDNESS IN HOME SERVICES Agency. The Client or their representative will be advised that DISCOVERING KINDNESS IN HOME SERVICES will investigate the instance and provide them with a response.

Initial Acknowledgement

Not Accepting Any Money/Gifts:

You are not to accept cash or gifts of any kind from clients past or present, or from their relations. The employee is not to give cash or gifts of any kind to the client or any of their relations. Examples include: client giving money or items in exchange for additional private services, caregiver/staff purchasing items for clients using caregiver/staff money and expecting to be reimbursed or paid back from client or client buying any items for caregiver/staff.

Initial Acknowledgement

Employee Funded/Payroll Deduction Friendly:

MyCTSavings is an exciting new retirement savings program, overseen by the Connecticut Office of the State Comptroller. It’s a new seamless way to help Connecticut employees save and plan for the future. MyCTSavings, employers can offer a great new benefit and employees can save in a convenient account they can take wherever their career leads.

Initial Acknowledgement

CT Paid Leave (CTPL):

As a covered employee in the State of Connecticut, the Connecticut Paid Leave (CTPL) program presents the opportunity for you to take time to take care of yourself and your family’s health needs without worrying about loss of income while you are away from work. Connecticut’s Paid Family and Medical Leave Act (PFMLA) allows employees access to paid leave for life events covered under the federal Family and Medical Leave Act of 1993 (FMLA), the Connecticut Family and Medical Leave Act (CT FMLA) and the Connecticut Family Violence Leave Act

Initial Acknowledgement

Driver/Non-Driver:

I am required to identify as a driver or non-driver, and I understand that false information or misrepresentation to this statement may have consequences in including legal ramifications. If my status changes, I understand that it will be my responsibility to notify my employer so that they can notify DISCOVERING KINDNESS IN HOME SERVICES of my status.

Option

I declare that I will be driving and that my vehicle is in good/safe working order and that as a driver my driver’s license is active and valid.

I declare that I will NOT be driving for any work-related activities whether paid or unpaid and will not have any clients or employees or any one in connection to DISCOVERING KINDNESS IN HOME SERVICES in my vehicle at any time.

Initial Acknowledgement

Conflict of Interest:

I understand I must avoid any relationship or activity that might impair, or even appear to impair, their ability to make objective and fair decisions when performing my job. Any situation that may conflict with DISCOVERING KINDNESS IN HOME SERVICES must be reported to Human Resources.

Employees with a conflict-of-interest question should seek advice from management. Before engaging in any activity, transaction or relationship that might give rise to a conflict of interest, employees must seek review from the Human Resource department.

Option

I hereby affirm that I know of no issues that would present a conflict of interest arising from any situation related to my involvement/association with DISCOVERING KINDNESS IN HOME SERVICES.

I may have a conflict arising from the following situation: (Describe the potential conflict, including both the other entity in which you have an interest and the dealings it has with DISCOVERING KINDNESS IN HOME SERVICES and the appropriate date(s) the conflict arose.)

Describe situation below:

Employee Handbook Acknowlegement

Employee Name:*

First Name Middle Name Last Name

EMPLOYEE HANDBOOK ACKNOWLEDGEMENT & RECEIPT

The employee handbook describes important information about DISCOVERING KINDNESS IN HOME SERVICES LLC Agency, and I understand that I should consult my manager or Human Resources regarding any questions not answered in the handbook. I entered my employment relationship with DISCOVERING KINDNESS IN HOME SERVICES LLC Agency voluntarily and acknowledge that there is no specified length of employment. Accordingly, either I or DISCOVERING KINDNESS IN HOME SERVICES, LLC Agency can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand and agree that, other than the CEO of the company, no manager, supervisor or representative of DISCOVERING KINDNESS IN HOME SERVICES LLC Agency has any authority to enter into any agreement for employment other than at will; only the CEO of the company have the authority to make any such agreement and then only in writing signed by the CEO of DISCOVERING KINDNESS IN HOME SERVICES LLC, Agency.

This handbook and the policies and procedures contained herein supersede any and all prior practices, oral or written representations, or statements regarding the terms and conditions of my employment with DISCOVERING KINDNESS IN HOME SERVICES LLC Agency. By distributing this handbook, the company expressly revokes any and all previous policies and procedures that are inconsistent with those contained herein.

I understand that, except for employment-at-will status, any and all policies and practices may be changed at any time by DISCOVERING KINDNESS IN HOME SERVICES LLC Agency, and the company reserves the right to change my hours, wages and working conditions at any time. Continued case assignment is not a guarantee for periods of leaves or extended absences lasting more than 10 days.

All changes will be communicated through official notices, and I understand that revised information may supersede, modify or eliminate existing policies. Only the CEO of DISCOVERING KINDNESS IN HOME SERVICES LLC Agency can adopt any revisions to the policies in this handbook.

I understand and agree that nothing in the Employee Handbook creates, or is intended to create, a promise or representation of continued employment and that employment at DISCOVERING KINDNESS IN HOME SERVICES LLC Agency is employment at will, which may be terminated at the will of either DISCOVERING KINDNESS IN HOME SERVICES LLC Agency or myself. Furthermore, I acknowledge that this handbook is neither a contract of employment nor a legal document. I understand and agree that employment and compensation may be terminated with or without cause and with or without notice at any time by DISCOVERING KINDNESS IN HOME SERVICES LLC Agency or myself.

I have received the handbook, and I understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it.

Signature*

Date*

MM slash DD slash YYYY

Acknowledgement of Job Title/Descriptions & Rates

Employee Name:*

First Name Middle Name Last Name

ACKNOWLEDGEMENT OF JOB TITLES/DESCRIPTION & RATES

I understand that I am hired as a DISCOVERING KINDNESS IN HOME SERVICES LLC per diem employee and that assignments may be on a case-by-case basis based on my qualifications and availability. The positions listed below are a brief description and the base rate of pay. Rates of pay are subject to change per assignment/client needs. * The brief job descriptions and responsibilities are taken from the actual job description. Refer to the actual job description for complete duties and responsibilities.

*I have checked the job title/description(s) for which I will agree to work and have signed below.

Option for ACKNOWLEDGEMENT OF JOB TITLES/DESCRIPTION & RATES

Responsible for non-medical, in home support services which provide for the comfort and safety, and general supervision of clients as well as home management services and medication reminders. Provides companionship to hose individuals requiring socialization and/or minimum guidance to assure a safe, protected, clean and orderly environment.

PCA/CNA/Rate $16.35 Help clients by supporting personal hygiene and daily living needs and perform services consistent with companion and homemaker and provide medication reminders as described above. Maintain client stability by monitoring and reporting any changes in behavior and/or condition.

Recovery Support Aide 1(Mental Health)/Rate $17.00 To help a participant to maintain a home/apartment by using existing natural supports and fostering involvement in social and community activities.

Live-In/Rate $199.92 per day (24 hours) Perform PCA/CNA duties and responsibilities in support of the patient's care needs and safety.

ABI (Acquired Brain Injury) Live-In – PCA Rate $199.92 per hour The rate is dependent on services provided. The ABI positions are consistent with the chore, companion, homemaker and PCA descriptions as listed above while servicing clients with an ABI.

ABI/RA (Recovery Aide)/Rate $17.00 Promote participant’s strengths and abilities to maintain and foster community living skills in the participant’s plan of care. Activities include improving socialization; self-advocacy; the development of natural supports; communication and coordination with service providers and others in support of the participant. Can provide ADL’s and have a role cueing with support of a med box for medications.

ABI/RA (Recovery Assistant II)/Rate $ 17.00 Assists the individual with safety monitoring; assistance with activities of daily living (hands-on and cueing) and integration into the community. Services provided in the individual's residence or I n the community. Provide health and safety monitoring.

ILST (Independent Learning Skills Training)/Rate $17.00 Services delivered independently or in the community. Follow Cognitive/Behavioral Plans. Provide ILST to include assessment and training in: self-care; medication management; task completion; communication and interpersonal skills; socialization; sensory/motor skills; mobility and community transportation skills; problem solving skills; and money management and ability to maintain a household.

Signature*

Date*

MM slash DD slash YYYY

Employee Commitment/Job Responsibilities

Employee Name:*

First Name Middle Name Last Name

MY COMMITMENT AS A CAREGIVER, I WILL NOT . . .

Use the client’s personal property without the client’s consent including phone for personal calls.
Consume the client’s food and beverages.
Forge client’s signature or falsify documentation or inaccurately clock in/out using EVV systems.
Bring friends, relatives, pets or any unauthorized individual to the client’s home.
Transport client away from home to take the client to my place of residence (home).
Breach client’s privacy or divulge client information – NO taking/posting any photos, videos, audio (unless for treatment as notification to supervisor/manager.
Consume alcoholic beverages, medicine, drugs, or other chemical substances not in accordance with the legal, valid, prescribed use and/or in any way that impairs my delivery of services to the client while in the client’s home or prior to the service delivery.
Smoke in the client’s home, regardless if the client smokes.
Watch TV, computer, play video games or sit around and chat on the phone in excess that will prevent me from providing proper service or prevent me from engaging with client.
Steal, borrow, accept, obtain or attempt to obtain money or anything of value, including gifts or tips from the client, household members and family members of the client or caregiver.
Discuss personal problems, religious or political beliefs with the client and others in the care setting.
Engage in non-care related socialization and relationships that crosses boundaries.
Provide care to individuals other than the client.
Sleep at the client’s residence (unless as authorized per live-in shift work).
Engage in sexual conduct or in conduct that may reasonably be interpreted as sexual in nature, regardless of whether the contact is consensual with the client or not.
Engage in behavior that may reasonably be interpreted as inappropriate involvement in the client’s personal relationships.
Engage in behavior that causes or may cause physical, verbal, mental or emotional distress or abuse to the client.
Be designated to make decisions for the client in any capacity involving a declaration for mental health treatment, power of attorney, durable power of attorney, or guardianship.
Sell or purchase from the client products or personal items. The only exception to this prohibition occurs when the client is a family member, and the provider is not delivering services.
Engage in behavior that constitutes a conflict of interest or takes advantage of or manipulates services contracted by DISCOVERING KINDNESS IN HOME SERVICES, resulting in an unintended advantage for personal gain that has detrimental results for the client, the client’s family or caregivers, or another provider.
Leave the home for a purpose not related to the provision of services without notifying the agency supervisor, the client’s emergency contact person, any identified caregiver, and/or the client’s care manager, or for client-directed services providers, leave the home without the consent and/or knowledge of the client or when not properly relieved according to care plan.
Extend the relationship and/or scope of service with the client beyond the specific services and/or the dates and times of service as described in the care plan. Such action may constitute crossing boundaries. (This includes providing extra services and/or time not described in care plan.)
Engage in a disagreement with the client but instead seek to improve communication and express willingness to work together constructively. In the event of a disagreement contact the Supervisor immediately. A disagreement is a failure or refusal to agree which may escalate into a conflict or quarrel.
Deny service to a client based on race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, or age, in accordance with discrimination laws.

DISCOVERING KINDNESS IN HOME SERVICES does not make the distinction between behavior and language that are the result of a condition verses someone who consistently displays inappropriate, intolerable behavior/language or threatening behavior/language. Providers must comply with OSHA standards and the Fair Labor Standard Act for employees. Also applies to language other than English. Report any inappropriate language and/or behavior to your direct supervisor.

Signature*

Date*

MM slash DD slash YYYY

CT Tuberculosis (TB) Risk Assessment

Employee Name:*

First Name Middle Name Last Name

CONNECTICUT TUBERCULOSIS (TB) RISK ASSESSMENT

See the Connecticut TB Risk Assessment User Guide for more information about using this tool.

Use this tool to identify asymptomatic adults and children for latent TB infection (LTBI) testing.
This tool can be used for school-aged children to determine if a student should have a TB test.
This risk assessment does not supersede any TB testing mandated by statute, regulation or policy.
Do not repeat testing unless there are new risk factors since the last test. If initial negative screening test occurred prior to 6 months of age, repeat testing should occur at age 6 months or older.
Do not treat for LTBI until active TB disease has been excluded: For persons with TB symptoms or an abnormal chest x-ray, evaluate for active TB disease with a chest x-ray, symptom screen, and if indicated, sputum acid-fast bacilli (AFB) smears, cultures and nucleic acid amplification testing (NAAT). A negative tuberculin skin test (TST) or interferon gamma release assay (IGRA) does not rule out active TB disease.

LTBI testing is recommended if any of the boxes below are checked.

Birth, travel, or residence for at least 1 month in a country with an elevated TB rate (Includes any country other than the United States, Canada, Australia, New Zealand, or a country in western or northern Europe; If resources require prioritization within this group, prioritize patients with at least one medical risk for progression (see the Connecticut Tuberculosis Risk Assessment User Guide for this list; IGRA is preferred over TST for non-U.S.-born persons ≥2 years old

Immunosuppression, current or planned. (HIV infection, organ transplant recipient, treated with TNF-alpha antagonist (e.g., infliximab, etanercept, others), steroids (equivalent of prednisone ≥2 mg/kg/day, or ≥15 mg/day for ≥1 month) or other immunosuppressive medication)

Close contact to someone with infectious TB disease. (Should test if patient has never been tested for this exposure)

Treat for LTBI if TB test result is positive and active TB disease is ruled out.

None of the above: No TB testing is indicated at this time.*

*See The Connecticut TB Risk Assessment: User Guide section “Local recommendations, mandated testing and other risk factors.”

CT TB Risk Assessment and User Guide_July 2019

Employee Signature*

Date of Birth*

MM slash DD slash YYYY

Provider Name

Assessment Date

MM slash DD slash YYYY

Hepatitis Vaccination/Waiver

Employee Name:*

First Name Middle Name Last Name

HEPATITIS B VACCINE ACCEPTANCE/WAIVER

In understand that due to my occupational exposure to blood or other potentially infectious materials, I may be at risk of acquiring Hepatitis B (HBV) infection. I have been given the opportunity to be vaccinated with the Hepatitis B Vaccine at no charge to me.

I have decided . . .

Request that I receive the Hepatitis B vaccine.

Decline the vaccination at this time.

Titre evidence immunity.

Previous Hepatitis B vaccination.

Medical contraindications. Contraindications include: Pregnancy, active infection such as cold or bronchitis, lactation, or allergy to yeast or yeast products. I understand that by declining the vaccine, I continue to be at risk of acquiring Hepatitis B Virus (HBV) infection. If in the future, I continue to have occupational exposure to bold or any other potentially infectious materials, and I want to be vaccinated with the Hepatitis B vaccine, I will consult my physician and obtain written approval before receiving the Hepatitis B vaccine. I understand that I can then obtain the Hepatitis B vaccine at no charge to me.

Decline vaccination for other personal reasons. I understand that by declining the vaccine, I continue to be at risk of acquiring Hepatitis B Virus (HBV) infection. If in the future, I continue to have occupational exposure to bold or any other potentially infectious materials, and I want to be vaccinated with the Hepatitis B vaccine, I understand that I can then obtain the Hepatitis B vaccine at no charge to me.

Signature*

Date*

MM slash DD slash YYYY

Health Screening (Covid/Flu/Communicable Disease)

Employee Name:*

First Name Middle Name Last Name

HEALTH SCREENING - (COVID/FLU/COMMUNICABLE DESEASE)

In order to protect the health and welfare of our employees and those with whom they have contact at work, Discovering Kindness In Home Services LLC reserves the right to condition employment upon receipt of a satisfactory statement of a licensed physician.

Please have your provider complete the Health Certification in your Employee Handbook OR obtain a doctor's note stating . . .

"The individual listed above is physically and medically qualified to perform the duties to be assigned and has no health condition that would create a hazard or safety issue to our clients. The individual is free of communicable disease. Furthermore, the individual has not limitations and is able to perform the required job functions. The individual has had a PPD placed on _____ and read on _____ with the results of _____. "

Whenever an employee suffers an illness, injury or disability, the employee may be asked to provide a physician's statement that verifies the nature of an illness, injury or disability, beginning and ending dates, the employee's ability to work, and any associated health risk to the employee, co-worker or others. All medical data provided including this physician's verification is confidential and shall be accessed only when necessary to determine matters relevant to the placement and/or continued employment of the employee.

ONLY Check ONE Option Below:

I testify that I am physically and mentally qualified to perform the duties to be assigned and have no health condition that would create a hazard or safety issues to our clients/co-workers. I further testify that I am free of communicable disease and have not limitations and I am able to perform the required job functions.

I testify that I am NOT physically and mentally qualified to perform the duties to be assigned and may have a health condition that would create a hazard or safety issues to our clients/co-workers. I will contact my Human Resources Administrator for further communication and instructions.

Received COVID Vaccin/Booster

Received Flu Vaccine

Date of Last COVID Vaccine or Booster

MM slash DD slash YYYY

Date of Last FLU Vaccine

MM slash DD slash YYYY

Signature*

Date*

MM slash DD slash YYYY

Emergency Contact Information

Employee Name:*

First Name Middle Name Last Name

EMERGENCY CONTACT INFORMTION

In the event of an emergency while at work, DISCOVING KINDNESS IN HOME SERVICES may need to notify an individual to disclose my condition, status or seek additional information. I authorize the individual(s) listed below to be contacted to disclose only information pertaining to my condition, status in the event of an emergency at work.

Name of Individual:

Relationship:

Contact Number:

Name of Individual:

Relationship:

Contact Number:

Direct Deposit

Employee Name:*

First Name Middle Name Last Name

AUTHORIZATION FOR DIRECT DEPOSIT

(Please attach a voided check for each bank account to which funds should be deposited.)

Option

START: Direct Deposit to the account(s) indicated below and, if necessary, to adjust or reverse a direct deposit for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such a way as to afford DISCOVERING KINDNESS IN HOME SERVICES LLC a reasonable opportunity to act on it.

UPDATE: Direct Deposit to the NEW account(s) indicated below and, if necessary, to adjust or reverse a direct deposit for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such a way as to afford DISCOVERING KINDNESS IN HOME SERVICES LLC a reasonable opportunity to act on it.

STOP: Direct Deposit to the existing account(s).

PRIMARY DIRECT DEPOSIT

Name of Bank:

Bank Account Number:

Bank Account Routing Number:

$ Dollar Amount:

Select Account Location:

Select How to Deposit

Option

*Balance of pay to Secondary account described below. *Note: Split payments are not available for contractors

SECONDARY DIRECT DEPOSIT (balance after direct deposit entry above)

Name of Bank:

Bank Account Number:

Bank Account Routing Number:

Select Account Location:

Signature*

Date*

MM slash DD slash YYYY

Handouts/Resources

Employee Name:*

First Name Middle Name Last Name

CLICK ON THE LINKS BELOW TO VIEW THE FULL HANDOUTS/RESOURCES

EVV - Electronic Visit Verification Sandata Calling In/Out Using Telephone Process (video)
https://youtu.be/-YgKl8ZD1IU

EVV - Electronic Visit Verification Sandata Mobile Connect App Demo Video (video)
https://youtu.be/YLk80F2CWgg

Establishing Boundaries as a Caregiver (video)
https://youtu.be/yl7jLCyMxfE

Preventing the Spread - Universal Precautions (video)
https://youtu.be/HU2TTPANIF8

How to Safely Remove Disposable Gloves (video)
https://youtu.be/YGLdmdGukb4

CT Elder Abuse
psebrochure.pdf

CT Sexual Harassment Poster
sexual-harassment-prevention-poster-english.pdf

Tuberculosis (TB Resources
Tuberculosis (TB) | Tuberculosis (TB) | CDC

Hepatitis B Resources
Hepatitis B Basics | Hepatitis B | CDC

CT Paid Sick Leave
psl-english-poster-effective-1-1-2025.pdf

CT Paid Leave (FML)
CT Paid Leave

My CT Savings Program
Program Details - MyCTSavings

CT Emergency Preparedness Booklet
emerprepguidepdf.pdf

I have had the opportunity to view the handouts and ask questions to the information provided. I further acknowledge that I understand the information and know that I have access to the information.

Signature*

Date*

MM slash DD slash YYYY

Employee Orientation

Employee Checklist

ORIENTATION CHECKLIST

Employee Acknowledgement of Policies/Procedures

EMPLOYMENT ACKNOWLEDGEMENT & RECEIPT OF HANDBOOK

Employee Handbook Acknowlegement

EMPLOYEE HANDBOOK ACKNOWLEDGEMENT & RECEIPT

Acknowledgement of Job Title/Descriptions & Rates

Employee Commitment/Job Responsibilities

MY COMMITMENT AS A CAREGIVER, I WILL NOT . . .

CT Tuberculosis (TB) Risk Assessment

CONNECTICUT TUBERCULOSIS (TB) RISK ASSESSMENT

Hepatitis Vaccination/Waiver

HEPATITIS B VACCINE ACCEPTANCE/WAIVER

Health Screening (Covid/Flu/Communicable Disease)

HEALTH SCREENING - (COVID/FLU/COMMUNICABLE DESEASE)

Emergency Contact Information

EMERGENCY CONTACT INFORMTION

Direct Deposit

AUTHORIZATION FOR DIRECT DEPOSIT

PRIMARY DIRECT DEPOSIT

SECONDARY DIRECT DEPOSIT (balance after direct deposit entry above)

Handouts/Resources

CLICK ON THE LINKS BELOW TO VIEW THE FULL HANDOUTS/RESOURCES

Quick Inquiry