Caregiver Job Acknowledgment Form

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Caregiver Job Responsibilities Acknowledgment Form

By signing this form, you acknowledge that you have read and understood the following job responsibilities. Please initial next to each statement to confirm your understanding.

I understand professional standards require scrubs, proper footwear, and a name tag while on duty.

I understand employees compensation ranges differs per insurance payors and will be communicated.

I understand employees are paid biweekly, with paychecks issued the Friday after each pay period, and that direct deposit is preferred.

I understand that full-time employment consists of 30 or more hours per week and includes benefits eligibility; part-time is defined as fewer than 30 hours per week.

I understand that Paychex Flex is used for payroll and benefits enrollment, and I will receive an invitation to complete onboarding.

I understand I must use the SmartCare App to clock in/out at the client’s home. Anything beyond 0.10 miles is non-compliant and may lead to disciplinary action. If issues occur, I will use the manual EVV timesheet.

I understand that employees must register with Payactiv to access payroll advances.

I understand that punctuality is essential and that excessive absences or no-shows may result in termination.

I understand that I must notify the office at least 24 hours in advance when calling out of a scheduled shift.

I understand that clients must not be left alone. If a replacement is needed, I will call the office immediately.

I understand that I must obtain consent and notify the office before leaving a shift early.

I understand that hourly employees are paid their regular rate on holidays unless it is a private pay case. They are not penalized for choosing not to work on a holiday, but they must inform the client in advance. Please note that Medicaid cases do not include holiday pay. Recognized holidays include: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas

I understand that when shopping for clients, they must provide payment (cash, check, or EBT/food stamp card) in advance.

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Caregiver Job Responsibilities Acknowledgment Form

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