Orientation & Training Sign-Off

Orientation & Training Sign-Off
Name*

First NameLast Name
Title
Email
example@example.com
Date of Hire: *

MonthDayYear
60 Days from Date ofHire:*

MonthDayYear
Orientation Completion Date:*

MonthDayYear
Date of first unsupervised direct service to a consumer:*

MonthDayYear
Can be past or future.
Within 60 calendar days of hiring direct support staff, C4E provided and ensured completion of 10 hours of orientation of direct support staff providing basic services that combines supervised on-the-job training with review of and instruction in the [required] areas.

Individual Needs Orientation – Before having unsupervised direct contact with a person served by the program, or for whom the staff person has not previously provided direct support, or any time the plans or procedures are revised, the staff person reviewed and received instruction on the requirements as they relate to the staff person's job functions for that person.
Orientation - Please check all completed topics. *
Training*
By signing here, I verify that the above training has been provided to me.

I have been oriented to Care4Everyone’s Policies and Procedures.

I understand the information provided and have had the opportunity to ask questions.

I understand the Agency’s policies and procedures and hereby agree to abide by them.

I understand that revisions to these policies & procedures may occur and it is my responsibility to adhere to all revisions, as stated.

Furthermore, I understand that adhering to these policies is a condition of employment and/or continued employment.
Signature*
Date*

MonthDayYear
Date
Should be Empty: