Employee Name	Social Security Number
Interviewed by	Date
Hired by	Hire Date
ALL EMPLOYEES: PRE-EMPLOYMENT PACKET

All documents due 1 week prior to beginning work. Be aware that background screening can take as long as 2 weeks to clear.

Complete and return with completed documentation so that this Pre-Employment Packet can be retained in the Employee file.
EMPLOYMENT DOCUMENTS	EMPLOYEE COMPLETED/ RETURNED TO SUPERVISOR	SUPERVISOR REVIEWED/

INITIALS
PRE-HIRE DOCUMENTATION: Provide all documentation to the office or supervisor 1 week prior to work.
Application (must show last 3 years of work and level of education)
References (must be verified)

#1

#2

#3
I9 Form
Liability Clause (automobile insurance waiver)
Employee/Employment Contract(s)
Copies

• Driver License	• Social Security Card	• Car Insurance

• Diploma/Degree	• Transcripts
Signed and notarized:

• Affidavit of Good Moral Character

• Affidavit of a Position of Trust (IHSS)
Local Law Enforcement Check (see supervisor for any forms needed)
Background Fingerprint Screening (see supervisor for any forms needed)
Provider Certification & Verification - completed by supervisor based on work and education check.
TRAINING: You are required to complete required and company determined training and sign policies annually. The Program Administrator will remind you when these are due, but you MUST submit the required proof that you have completed required training and signed the policies by the date they are due.
Meeting with Program Administrator

• Go over policies (obtain from Program Administrator)

• Go over Client-Specific Training

• Go over General Hire Training (documentation and training requirements)
PREHIRE Training (complete prior to beginning work)

• Zero Tolerance

• Medication Administration/Validation 65G-7 (if working with clients who take meds)

• Requirements for All Waiver Providers
PREHIRE SLC Training	Pre-Service Training (18 hours)
Introduction to SS Work Incentives
WITHIN 30 DAYS (complete within 30 days of hire)

• HIPAA

• Crisis Management Course (Reactive Strategies - 65G-8)
WITHIN 90 DAYS (complete within 90 days of hire)

• Direct Care Core Competency

• HIV/AIDS/Infection Control - obtain from Red Cross or other source

• CPR - obtain from Red Cross or other source

• First Aid - obtain from Red Cross or other source

• Overview of APD Waiver Provider Requirements
Company Training, as required	DD Waiver Services & Limitations Handbook
iBudget DD Waiver Services & Limitations Handbook
Bill of Rights
Person-Centered Planning	What is PCP?
The Process & Creating Goals
Other Training, as required

FOR OFFICE USE ONLY
BACKGROUND CHECK	DATE COMPLETED	DATE RECEIVED	OK/NOT OK TO WORK
Local Law Check Received (County)
FDLE Letter Received (FBI - National)