Live Well Healthcare Solutions Onboarding Packet Logo
  • Personal Information

    Part 1 of 4
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  • Ethnicity Descriptions

    Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of Race

    White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

    Black or African American: A person having origins in any of the black racial groups of Africa.

    Native Hawaiian or Other Pacific Islander: A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

    Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

    American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.

    Two or More Races: All persons who identify with more than one of the above five races.

  • Emergency Contact Information

  • PLEASE READ BEFORE SIGNING: My signature verifies that information provided in this application is true and complete. I understand the company is an Equal Opportunity Employer. I understand that falsification, including withholding of information, on this application is grounds for immediate dismissal if I am selected for a position. I further understand that if I am hired, I can be terminated, with or without cause and with or without notice. I agree to have my picture taken for identification purposes and to submit to drug screening tests upon request. I understand and hereby authorize Live Well Healthcare Solutions to request and receive from all prior employers within two years of the date of this application, any and all pertinent information concerning my prior employment and its termination, including the reasons for such termination. The agency has the right to run a criminal background check and may pass on the results upon request. I understand that the physical information that the employee must provide to our agency may be released to any facility upon their request.

    I respectfully authorize the release to SMS Cleaning and Housekeeping Serices LLC any and all information concerning any criminal, occupational, academic, or other information that might assist in determining my qualifications and fitness for the position I am seeking.

    I hereby release the furnishing organization or inidividual from any liability for the release of the information requested above.

    Federal regulations require us to request a Social Security Number from every employee to whom compensation is paid. Employee SSNs are maintained and used by Live Well Healthcare Solutions for payroll and benefits purposes, to verify employment history, and are reported to Federal and State Agencies on forms required by law or for benefits purposes. Live Well Healthcare Solutions will not disclose an employee's SSN without the consent of the employee to anyone outside Live Well Healthcare Solutions except as mandated by law or as required for benefit purposes. Failure to provide an SSN may result in the withdrawal of an offer of employment and/or the denial of benefits.

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  • Employment History

  • EMPLOYER 1

  • Dates of Employment

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  • EMPLOYER 2

  • Dates of Employment

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  • Educational Background

  • Reference 1

  • Dates of Employment

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  • Reference 2

  • Dates of Employment

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  • I, THE APPLICANT, HEREBY REQUEST AND AUTHORIZE THE RELEASE OF ANY INFORMATION ABOUT ME that may be requested by the company for the purpose of this application for employment from former employers, persons, firms, corporations, educational institutions, law enforcement agencies, and the U.S. Government. I agree to Hold Harmless these persons or organizations, their officers, directors, employees and agents of liability, claims, damages, or demands of any nature arising from or related to the investigation of information contained in my application.

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  • PART 1 OF 4 COMPLETE

    Click NEXT below to continue to part 2

  • Company Forms

    Part 2 of 4
  • Agreement Regarding Resolution of Disputes

  • As a condition of my employment with SMS Housekeeping and Cleaning, LLC (“LiveWell”), I agree that except for the “Claims Not Subject to Arbitration” below, any dispute, controversy or claim arising between me and LiveWell (including, but not limited to, any dispute or claim concerning my employment, including termination of employment) shall be resolved by arbitration. This includes, but is not limited to, claims involving a violation of public policy, statutory claims under federal, state, or local law; and claims concerning wages or other compensation, whether based on statute or any other grounds.
    I understand that arbitration is an out-of-court resolution of a dispute between parties, decided by an impartial third party. By signing this, I am waiving my right to sue in court and have a jury trial.


    This Agreement Regarding Resolution of Disputes (“Agreement”) shall be governed by the Federal Arbitration Act and shall remain in force even after I separate from LiveWell for any reason.


    For purposes of this Agreement, a claim against any of LiveWell’s owners, employees, subsidiaries, affiliates, or the owners or employees of any such entities, will be considered a claim against LiveWell.


    I agree that arbitration will be administered by the American Arbitration Association (“AAA”) and that the AAA’s Employment Arbitration Rules will govern, except as modified by this Agreement. I understand that the AAA’s Employment Arbitration Rules are available online at www.adr.org.


    The costs for the arbitration will be governed by the AAA’s policy on costs for employment-related disputes. That policy currently provides that the initial filing fee for an employee will be no more than $300 (which may be waived under certain circumstances), and that the employer will be responsible for
    all other filing fees, administrative fees, hearing fees, and arbitrator compensation. In the event that the AAA’s initial filing fee is higher than the filing fee for a court action in the trial court in the jurisdiction where I reside, I will only be required to contribute the cost of what I would have paid to file an action in
    court.


    Arbitration proceedings will be conducted by a single arbitrator. The arbitrator shall be bound by the terms of any and all written agreements between LiveWell and me and by applicable law I agree that except for the “Claims Not Subject to Arbitration” below, any dispute or claim between LiveWell and me will be resolved on an individual basis only. No arbitration shall include any disputes or claims on behalf of any other employees, such as class actions or collective actions. The arbitrator shall not have the authority to hear or issue any award concerning the claims of a class action or collective action or to consolidate the claims of more than one employee or the claims of a class of employees into a single arbitration proceeding, to the maximum extent permitted by law. If LiveWell or I have any disagreement about whether an arbitration can include any dispute or claim on behalf of any other employees, that disagreement will be decided by a court, not by an arbitrator.


    LiveWell agrees that should there be arbitration proceedings in accordance with this Agreement, I would be free to pursue all available substantive or procedural rights or remedies in such arbitration proceedings. For example, this agreement does not alter any applicable statute of limitations and does not prevent the arbitrator from awarding all types of damages available under any applicable statute or common law.


    Claims Not Subject to Arbitration: The following claims are not required to be resolved by arbitration: claims involving a sexual harassment dispute or a sexual assault dispute. Claims not subject to arbitration shall be decided by a judge without a jury.

    I agree that if any court of competent jurisdiction were to determine that any portion of this agreement to arbitrate exceeds the scope permitted by applicable law, the court shall have the authority to modify or “blue pencil” such portion so as to render it enforceable while maintaining the parties’ original intent to the maximum extent possible. If a court determines that a legal dispute may not be resolved by arbitration for any reason, the dispute or claim shall be decided by a judge, without a jury.


    I UNDERSTAND THAT IN A LAWSUIT IN COURT, I WOULD HAVE CERTAIN RIGHTS TO A TRIAL BY A JURY OR A JUDGE. I VOLUNTARILY AND KNOWINGLY FOREVER WAIVE AND GIVE UP THE RIGHT TO HAVE A JUDGE OR A JURY DECIDE ANY DISPUTES OR CLAIMS COVERED BY THIS AGREEMENT. I UNDERSTAND THAT ALL DISPUTES OR CLAIMS RELATING TO MY EMPLOYMENT (OR TERMINATION OF EMPLOYMENT) WILL INSTEAD BE DECIDED BY AN ARBITRATOR. I UNDERSTAND THAT I HAVE A RIGHT TO CONSULT WITH A PERSON OF MY CHOOSING, INCLUDING AN ATTORNEY, BEFORE SIGNING THIS AGREEMENT.


    I understand that my employment with LiveWell is at-will, which means that either LiveWell or I may terminate the employment relationship for any reason, at any time, with or without notice.


    By signing this Agreement, I am affirming that I have carefully read this Agreement and agree to be bound by its terms.


    I agree that my electronic signature/acceptance of this Agreement shall have the same binding effect as a handwritten signature and acceptance.

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  • Handbook Acknowledgement Form

  • PLEASE READ THIS FORM CAREFULLY


    A copy of the Live Well Healthcare Solutions Employee Handbook is issued to all Employees and is available to all employees from the Regional Director. While our Handbook cannot cover everything, it introduces you to some of our programs, policies, and benefits, and tells you about some of the things we expect of all of our Employees. This Handbook is not an employment contract, nor does it guarantee employment for any specific duration. The purpose of the Handbook is to supply you with basic guidelines and generalized information. Live Well Healthcare Solutions may revise the contents of the Handbook at any time, as well as any Company policy or benefit, to meet the best interests of our Employees, patients, and the Company.


    Employment with Live Well Healthcare Solutions is based upon the consent of both the Company and the individual Employee, and either has the freedom to end this employment relationship at any time, for any reason, with or without notice and with or without cause.

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  • Direct Deposit Form

  • Please click here to upload a voided check OR a letter from your bank with Account & Routing Info OR a screenshot of your direct deposit information.
    Cancelof
  • I hereby authorize Live Well Healthcare Solutions to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my account indicated below and the depository name(s) below, hereinafter called depository, to credit and/or debit the same as such.

    Direct Deposit is made at the the sole discretion of the company for the benefit of our employees. Direct Deposit may be cancelled at any time based on the needs of the company. Upon termination of my employment (voluntary or otherwise), the company reserves the right to cancel direct deposit on my final paycheck and to instead issue an actual check directly to me, less any monies owed to the company.

    *Please notify payroll immediately if you close or change your bank account.

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  • Acknowledgement of Privacy Obligations under HIPAA

  • I understand that it is the intent of SMS Housekeeping and Cleaning LLC (the Company) to safeguard and protect the privacy of its applicant’s and employees’ “protected health information” as defined by the Health Insurance Portability and Accountability act of 1996 (“HIPAA”).


    I understand that “protected health information” includes individually identifiable information, maintained or transmitted through any medium, relation to an individual’s past, present, or future physical or mental health or healthcare. Health information is considered individually identifiable if it either identifies a person by name or creates a reasonable basis to believe the individual could be identified (through identifiers such as address, social security number, dates of service, telephone number, email address, or vehicle identification number).


    In the course of my employment with the Company, I understand that I may come into contact with protected health information of applicants or employees. In consideration of my employment and/or continued employment with the Company, I hereby agree that I will not at any time (either during my employment with Company, or anytime thereafter) access, use, or disclose to any person or entity, any protected health information of the Company’s applicants or employees, except as necessary and authorized in the course of my duties and responsibilities for the Company. I understand that this confidentiality obligation applies regardless of the manner in which I acquired the protected health information, whether it was communicated verbally, in writing, electronically, or in any other format, and regardless of whether it was communicated directly to me or intended for my access. I understand that this obligation survives the termination of my employment with the Company, regardless of the reason for such termination.


    I understand that the unauthorized access, use, or disclosure of protected health information in violation of this policy may subject me to disciplinary action up to and including termination of my employment. I also understand that violating the privacy rights of individuals under HIPAA may also result in the imposition of civil and/or criminal penalties and other sanctions provided by federal and state laws.

    By signing below, I acknowledge that I have read this policy and that I understand my obligations as an individual and member of the Company to protect the confidentiality of protected health information relating to any employee or applicant.

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  • Patient/Resident Abuse

  • Patient/Resident Abuse is an intentional act or a failure to act that causes or creates a risk of harm to an older adult, age 60 or older. Often, the perpetrators of elder abuse are caregivers or other people whom the elder person trusts.


    Nursing home abuse and neglect can occur in many different forms.
    These forms of abuse include:

    1. Physical Abuse
    2. Emotional and Psychological Abuse
    3. Sexual Abuse
    4. Financial Abuse
    5. Neglect

    Any employee guilty of abusing a patient/resident is subject to immediate discharge. Local and State Authorities will be notified immediately, and criminal charges may be filed against any employee guilty of abuse.

    If you see or hear of any form of Patient/Resident Abuse you must report it immediately to the Facility Administrator/DON and Live Well Human Resources Department.

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  • Clock In Clock Out Policy

  • This Clock In Clock Out Policy is meant to provide timekeeping requirements and best practices for all eligible employees.


    All eligible employees are required to record their hours using the ADP Timeclock. Employees are required to clock in at their scheduled start time. If they are late, they still must clock in at the time they arrive.


    All Staff must notify their manager or supervisor immediately regarding any lateness so service at the Center is not delayed.


    *Employees are not allowed to clock in or out prior to the scheduled beginning or end of the shift, unless authorized in advance by a manager.


    If an employee is unable to clock in or clock out, they cannot ask a colleague to do so for them. An employee must submit a request to their manager explaining why they were unable to clock in or out and the punch time that should have been recorded. Employees who miss a punch, regardless of the reason, must complete a Missed Punch Form to their direct supervisor within one business day of the missed punch.

    Employee hours will be rounded, in compliance with the Fair Labor Standards Act (FLSA). Company will round employee hours to the nearest quarter-hour. Example time records:
    ● Clock in at 8:06 AM rounded to 8:00 AM
    ● Clock in at 8:12 AM rounded to 8:15 AM
    ● Clock out at 4:58 PM rounded to 5:00 PM
    ● Clock out at 5:19 PM rounded to 5:15 PM


    By completing their punch in and out times correctly and daily on scheduled/approved shifts a time record from ADP will be provided to the manager and the employee certifies the accuracy of their time record. Their manager will review the record for accuracy before completing & submitting the Payroll Confirmation Sheet to their Regional.


    For hours worked over 40 in a workweek, employees will be paid time and a half.

     

    Procedures

    Employees are expected to clock in at their scheduled start time and clock out when they have completed all work assignments by scheduled departure time.
    If an Employee leaves the facility property they must clock out and clock back in when they return to work.


    Violations of this Policy

    • Forgetting to clock in or clock out, or having a technical error in doing so, will not result in disciplinary action unless it becomes routine.

    • Asking a colleague to clock in or out for them or clocking in or out at the request of another employee can result in immediate termination. Immediate termination will also occur when employees are found to “buddy punch,”

    • *Employees that clock in unauthorized & prior to the start of their shift will result in disciplinary action

    Disciplinary action will follow these steps:

    ● First Offense: Verbal Documented Counseling regarding this Policy and further violations

    ● Second Offense: A written warning in the employee’s personnel file, detailing the repercussions for further Policy violations

    ● Third Offense: Increased disciplinary action, Suspension up to and including termination

    ● Fourth Offense: Increased disciplinary action, up to and including termination

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  • Live Well Slip Resistant Shoe Policy

  • Purpose

    Live Well recognizes that slips and falls in the workplace are a leading cause of serious injuries. In addition, certain jobs include the potential for impact, puncture and chemical contact related injuries to the feet which also must be protected against. This policy has been established to provide information and practices to minimize these risks.

     

    Policy

    1.  To better protect our employees and create a safer working environment for everyone, Live Well has instituted a company-wide slip-resistant safety shoe policy. We have made every effort to design this policy to be flexible with the ability to meet our employees’ needs both on and off the job.

    Requirements: All employees working in Live Well Centers will be required to wear slip-resistant safety shoes that are in good condition.
    These shoes may be purchased at the following approved suppliers (list below).
    The list of suppliers was chosen to be effective in helping prevent slip and fall accidents. The shoes on the approved list also meet specific testing standards that show each shoe’s slip-resistance on wet and dry surfaces.
         a. Shoes for Crews – available online
         b. TredSafe – available at most Wal-Mart locations
         c. TX Traction – available at Famous Footwear locations or online
         d. Skechers Work – available at most shoe stores or online. Must be “Work” type.
         e. Safe-T-Step – available at Payless Shoe stores


    2. All employees must always wear slip-resistant shoes when working.

     

    Responsibilities

    Management and supervisors will be responsible for ensuring that they and all employees understand the need for proper footwear and for enforcing appropriate disciplinary action procedures where footwear is not worn properly.
    Employees are responsible for wearing proper slip resistant shoes when working.
    Failure to wear safety footwear as required by this policy will be treated in accordance with Live Well disciplinary action procedures which include possible termination of employment.
    Employees will wear footwear appropriate for their assigned work activities and site conditions.

     

    Examples of approprate footwear include shoes with:

    • Closed toes.
    • Shoes that provide good ankle support.
       

    Examples of inapproprate footwear include :

    • Flip flops or beach shoes
    • Open-toed or open-backed shoes
    • Slides or mules (backless shoes)
    • Sandals
    • Footwear with heels greater than 1”
    • Shoes with spiked heels
    • Platform shoes (soles greater than 1”)
    • Molded or plastic “gummy” shoes or "Crocs."
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  • Discrimination & Harassment Policy In-Service

  • Discrimination

    Live Well is an equal opportunity Employer and does not discriminate against any employee or applicant for employment because of age, ancestry, citizenship, color, disability, gender, gender identity of expression, marital status, national origin, race, religion, sex, sexual orientation, status as a victim of domestic violence, status as a Vietnam era or Special Disabled Veteran, your (or a dependent’s) reproductive health decision-making, or any other characteristic protected by federal, state or local laws.

    You should report every instance of perceived discrimination as well as concerns about equal employment opportunities in the workplace to your supervisor, your Regional Manager, or the Human Resources Department at hr@livewhs.com / HR Hotline #203-580-5690 Ext. 1 regardless of whether you or someone else is the subject of the perceived discrimination.

    Live Well will fully investigate complaints and take any action it deems appropriate, up to and including discharge. Additionally, the Company will not tolerate any form of retaliation against individuals who make any such report to Management, or against those who cooperate in the investigation of such reports.

    Harassment

    Live Well is committed to a positive, healthy work environment. It is our policy to prohibit harassment of any Employee on the basis of age, ancestry, citizenship, color, disability, marital status, national origin, race, religion, sex, sexual orientation, status as a victim of domestic violence, or any other characteristic protected by Federal, State or Local laws. The purpose of this policy is not to regulate personal morality. Rather, it is to ensure that all of us are free of harassment. While it is not easy to precisely define harassment, it certainly includes slurs, epithets, threats, derogatory comments, unwelcome jokes, teasing, sexual advances, requests for sexual favors and other similar verbal or physical conduct such as uninvited touching of a sexual nature or sexually related comments.

    Definitions of Harassment

    Harassment is verbal and/or physical conduct which denigrates or shows hostility to the individual towards whom the conduct is directed. Harassment includes teasing, pestering, and other disturbing and annoying behavior.

    Sexual Harassment

    Constitutes discrimination and is illegal under federal, state and local laws. For the purposes of this policy, sexual harassment is defined, as in the Equal Employment Opportunity Commission Guidelines, as

    • Unwelcome sexual advances
    • Requests for sexual favors and other verbal or physical conduct of a sexual nature when, for example:
        (i) submission to such conduct is made either explicitly or implicitly as a term or condition of an individual's employment.
        (ii) submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; or
        (iii) such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive working environment.

    Sexual harassment may include a range of subtle and not so subtle behaviors and may involve individuals of the same or different gender. Depending on the circumstances, these behaviors may include, but are not limited to:

    • Unwanted sexual advances or requests for sexual favors.
    • Sexual jokes and innuendo.
    • Verbal abuse of a sexual nature.
    • Commentary about an individual's body.
    • Sexual prowess or sexual deficiencies.
    • Leering, catcalls or touching.
    • Insulting or obscene comments or gestures.
    • Display or circulation in the workplace of sexually suggestive objects or pictures (including through e-mail); and other physical, verbal, or visual conduct of a sexual nature.

    Sex-based harassment - that is, harassment not involving sexual activity or language but directed at an employee because of his or her sex (e.g., male manager yells only at female employees and not males) - may also constitute discrimination if it is severe or pervasive harassment on the basis of any other Protected Characteristic is also strictly prohibited.

    Under this policy, harassment directed toward an individual because of any Protected Characteristic, or which is directed to an individual because of a Protected Characteristic of one of his/her relatives, friends or associates, and that:

    • Has the purpose or effect of creating an intimidating, hostile or offensive work environment.
    • (ii) has the purpose or effect of unreasonably interfering with an individual's work performance.
    • (iii) otherwise adversely affects an individual's employment opportunities.

    Harassing conduct includes, but is not limited to: teasing, epithets, slurs or negative stereotyping; threatening, intimidating or hostile acts; denigrating jokes and display or circulation in the workplace of written or graphic material that denigrates or shows hostility or aversion toward an individual or group (including through e-mail).

    You should report every instance of perceived discrimination as well as concerns about equal employment opportunities in the workplace to your supervisor, your Regional Manager, and /or the Human Resources Department at HR Hotline #203-580-5690 Ext. 1 of whether you or someone else is the subject of the perceived discrimination.

    Live Well will fully investigate complaints and take any action it deems appropriate, up to and including discharge. Additionally, the Company will not tolerate any form of retaliation against individuals who make any such report to Management, or against those who cooperate in the investigation of such reports.

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  • Workplace Violence In-Service

  • Purpose: Live Well is committed to a positive, healthy work environment. Providing a safe and secure work environment is an integral part of this commitment. Therefore, threats and acts of violence will not be tolerated under any circumstances.


    We will immediately respond to, assess and resolve all threats and acts of violence regardless of their nature. Much like the position the airlines have been forced to assume, we are not able to consider any threats as “jokes.” Accordingly, corrective action, up to and including discharge, will be taken.


    This is inclusive of Live Well’s Social Media /Internet Publication Policy stating Inappropriate postings that may include discriminatory remarks, harassment, and threats of violence or similar inappropriate or unlawful conduct will not be tolerated and may subject you to disciplinary action up to and including termination.


    If you know of any or even suspect any possible threats or acts of violence, report them to your supervisor immediately. In emergency situations, immediately call 911. 

     

    What is workplace violence?

    Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors. Acts of violence and other injuries is currently the third-leading cause of fatal occupational injuries in the United States.


    What should I remember most when learning about warning signs?

    You must remember that it can be very difficult to know when a person is going to be violent. While not all people will show the following signs, these types of behaviors and physical signs can serve as warning signs that a situation could turn violent. Always take these behaviors "in context". Look for multiple warning signs and for signs of escalation (the behaviors are getting worse).


    If you are concerned about a person who shows some or all of the identified characteristics, take action.


    Report your concern immediately to your supervisor, and our human resources department.
    hr@livewhs.com / HR Hotline #203-580-5690 Ext. 1

     

    What are signs that a worker may need support?

    Some behaviors may indicate a worker is struggling. While these behaviors do not necessarily mean a person will become violent, they may indicate that the worker is experiencing periods of high stress and needs support from the workplace.


    While not all people will show the following signs, these types of behaviors and physical signs can serve as warning signs. Always take these behaviors "in context". Is it a bad day or a pattern of behavior? Look for multiple warning signs and for signs of escalation (the behaviors are getting worse).


    Each situation is unique and professional judgment or outside assistance may be necessary to determine if intervention is necessary.


    Always take particular notes if:

    • There is a change in the workers’ behavior patterns.
    • The frequency and intensity of the behaviors are disruptive to the work environment.
    • The worker is exhibiting many of these behaviors, rather than just a few. 

    Warning Signs Include:

    • Crying, sulking or temper tantrums.
    • Excessive absenteeism or lateness.
    • Pushing the limits of acceptable conduct or disregarding the health and safety of others.
    • Disrespect for authority.
    • Increased mistakes or errors, or unsatisfactory work quality.
    • Refusal to acknowledge job performance problems.
    • Faulty decision-making.
    • Testing limits to see what they can get away with.
    • Swearing or emotional language.
    • Handling criticism poorly.
    • Making inappropriate statements.
    • Forgetfulness, confusion, or distraction.
    • Inability to focus.
    • Blaming others for mistakes.
    • Complaints of unfair personal treatment.
    • Talking about the same problems repeatedly without resolving them.
    • The insistence that they are always right.
    • Misinterpreting communications from supervisors or co-workers.
    • Social isolation.
    • Sudden and/or unpredictable change in energy level.
    • Complaints of unusual or non-specific illnesses.
    • Holding grudges, and verbalizing hope that something negative will happen to the person against whom they have the grudge.
       

    Are there physical signs that a person may act out?

    Sometimes it is not what a person says, but what their body is "doing". Use caution if you see someone who shows one or more of the following "non-verbal" signs or body language.

    • Flushed or pale face.
    • Sweating.Pacing, restless, or repetitive movements.
    • Signs of extreme fatigue (e.g., dark circles under the eyes).
    • Trembling or shaking.
    • Clenched jaws or fists.
    • Exaggerated or violent gestures.
    • Change in voice.
    • Loud talking or chanting.
    • Shallow, rapid breathing.
    • Scowling, sneering or use of abusive language.
    • Glaring or avoiding eye contact.
    • Violating your personal space (they get too close).
       

    Here are some things you can do if you encounter workplace violence:

    • Stay calm- Avoid rushing and try to be empathetic.
    • De-escalate- Try to sit down with the person, speak slowly and clearly, and provide short answers. You can also try to be helpful, such as by scheduling an appointment for a later time.
    • Maintain distance -Try to put some space between yourself and the other person. Avoid sudden movements or threatening gestures, like pointing.
    • Take action- If you or others are in danger, you can run or hide. If there's immediate danger or someone is injured, you can call 911. You can also try to contact your supervisor or other appropriate emergency contacts.
    • Take notes- If you're a witness, you can try to take notes about the incident, including the date, time, place, and names of any witnesses. You can also note any behavior that occurred, such as abuse, injustice, or humiliating remarks. 
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  • What should employers do following an incident of workplace violence?

    • Encourage employees to report and log all incidents and threats of workplace violence.
    • Provide prompt medical evaluation and treatment after the incident.
    • Report violent incidents to the local police promptly.
    • Discuss the circumstances of the incident with staff members. Encourage employees to share information about ways to avoid similar situations in the future.
    • Offer stress debriefing sessions and post- traumatic counseling services to help workers recover from a violent incident.
    • Investigate all violent incidents and threats, monitor trends in violent incidents by type or circumstance, and institute corrective actions.
    • Discuss changes in the program during regular employee meetings.
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  • PATIENT-RESIDENTS’ RIGHTS; ABUSE-NEGLECT AND THE ELDER JUSTICE ACT INSERVICE

  • Purpose: The purpose of this in-service, along with the Stop and Watch Inservice, is to train/educate all employees on the identification of and proper reporting and response for potential abuse, neglect and exploitation incidents with the intent to prompt investigation and to ensure the protection of patients/residents served.


    This in-service educates all new hires and current employees on Patients’/Residents’ Rights, Resident/Patient Abuse and the obligation to report suspected crimes under the Federal Elder Justice Act (EJA).

     

    Patient'/Resident' Rights

    The Company endorses and respects the patients’/residents’ right to privacy and the protection and preservation of their dignity, individuality, and independence. The facility is the home of the patient/resident, and all employees must conduct themselves accordingly.


    In addition to the material presented in this training, all employees are required to become familiar with, and follow the patients’/residents’ rights and abuse/neglect policies of the facility. The Company may require additional training on facility - specific patients’/residents’ rights policy and procedures. A typical policy provides for, among other things, the following patient/resident rights:

    1. Consideration, dignity, and respect in treatment and care.
    2. Privacy related to personal care, treatment, visits with family and friends, and communication.
    3. Use and quiet enjoyment of his/her room, including the right to close the door, and retain and use personal clothing and possessions.
    4. Participation in the planning of total care (including meal choices) and medical treatment, including being fully informed of medical condition, selecting a doctor, and refusing treatment.
    5. Participation in patient/resident councils to make complaints and recommend facility policy changes.
    6. Management of the patient's/resident's own financial affairs.
    7. Confidentiality of patient/resident records and their personal identifying information.
       

     

    What does this mean for employees?

     

    ► Respecting residents’ private space and property. This means, among other things, not changing the radio or television station without permission. Knocking on resident room doors and requesting permission to enter and closing resident room doors as requested. (F-550)


    ► When cleaning a resident room or assisting a resident, remember that personal items should be kept within reach for independent use in bathrooms by the resident. Bedroom furniture should be arranged to the residents’ or patients’ preferences as much as possible. (F-558)


    ► The resident has the right to be free from any physical restraints not required to treat the resident’s medical symptoms. When mopping floors, ask Nursing if they can assist by removing the resident from the room until the floor has dried. Never create any type of barrier that may prevent the resident from moving about—doing so is placing the resident under involuntary seclusion. (F-604 & F-689)


    ► Speak respectfully with residents or patients and address them with the name of their choice. (F-550 & F-557)


    ► Comfortable sound levels must be maintained in the facility. This means background noise and distractions such as cleaning equipment are kept to a minimum, so as not to interfere with visitation, activities and meals. Yelling down halls and disruptive staff behavior are not allowed. (F-584)


    ► The resident has the right to choose activities, schedules, and make choices about aspects of his/her life in the facility that are significant to the resident. This means the resident is within his/her rights to make requests or deny services. If a request is made directly to you and you are unsure of what to do, speak with your supervisor or Nursing Services. (F-561)


    ► The facility must listen to the views and act upon the grievances and recommendations of the resident/patient and their families. This means the resident, or their family may question decisions made that affect resident care and life in the facility. If you are asked a question regarding this, refer it to your supervisor or Nursing Services. (F-565)

     

    Resident and Patient Abuse

    Residents/patients have the right to be free from abuse. Residents must not be subjected to abuse by anyone including, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the resident, family members or legal guardians. Any employee found to have used verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion with a resident will be subject to suspension pending investigation and, if found to have used such, will be immediately terminated and reported to the appropriate state agencies, where they may be subject to criminal penalties or civil liability.


    If You See Abuse Or Neglect, You Must Report It (F-608, F-609 & F-601)


    Any employee who has ACTUAL knowledge of the abuse or neglect of a patient/resident, must demand the person to stop the abuse and immediately inform a supervisor. Actual knowledge means you see or personally hear the patient/resident being abused, or discover injuries of an unknown source, which requires further investigation.


    When reporting, if the supervisor is not immediately available, submit the complaint to the Administrator or Nursing Supervisor, and then inform your supervisor as soon as possible; failure to do so will result in disciplinary action up to and including termination. You are not expected to get into a physical altercation with the abuser, however, it is preferred, if you are able without fear of being assaulted, that you stop the abuse and use the resident’s phone to inform your supervisor, the Administrator or Nursing Supervisor while remaining in the room with the resident.


    Healthcare workers are mandatory reporters, which means they must report any instance of resident abuse to the state as well as to their employer.

     

    Immunity

    Any employee reporting abuse or neglect in which they are not involved is immune from discipline. Any employee making a bad faith, malicious, or reckless report may be subject to discipline by the Company.


    Obligation to Report Suspected Crimes Under Federal Elder Justice Act


    The Company complies with the Elder Justice Act (EJA) and requires all employees, managers, agents or contractors to report any reasonable suspicion of a crime against any individual receiving care in a facility to the state survey agency (SSA) and local law enforcement. The Company will notify all new employees, managers, agents or contractors and will annually notify all employees, managers, agents and contractors of their obligations under the EJA to report a suspicion of a crime. Furthermore, the Company will not retaliate against any employee who reports a suspicion of a crime against an individual receiving care in a facility. Any individual who has been prohibited from working in a long-term care facility because of failure to report a suspicion of a crime against a resident of a long term care facility will not be permitted to work for the Company.


    If you have questions regarding how to report an incident, please call/contact our HR Department at
    Email : hr@livewhs.com or HR Hotline #203-580-5690 Ext. 1 or speak with your supervisor.


    DEFINITIONS:


    “ABUSE” is the infliction of physical or mental injury, or the causing of the deterioration of a patient/resident, by any means including, but not limited to, sexual abuse, exploitation, or extortion of funds or other things of value, to such an extent that his/her health, morale, or emotional well-being is endangered.


    “NEGLECT” is the failure to provide the proper or necessary medical care, nutrition, or other services necessary for a patient/resident’s well-being.


    VERBAL ABUSE is defined as and refers to any use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within hearing distance. Verbal abuse includes, but not limited to threats of harm or frightening a patient/resident.


    SEXUAL ABUSE includes, but not limited to sexual harassment, sexual coercion, or sexual assault.


    MENTAL ABUSE includes, but not limited to humiliation, harassment, threats of punishment or deprivation.


    PHYSICAL ABUSE includes, but not limited to hitting, slapping, pinching, running into with objects, and kicking. This also includes controlling behavior through corporal punishment. (Use of physical force with the intention to cause pain, but not injury for purpose of correction or control of the resident’s behavior).


    MISAPPROPRIATION (THEFT) OF FUNDS or PROPERTY is defined as the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a patient/resident’s belongings or money without the resident’s knowing consent. Missing items are to be reported to your supervisor immediately. This includes but is not limited to items/money found in laundry.


    MISTREATMENT - the practice of treating someone badly; includes any or all of the above.


    INJURIES OF AN UNKNOWN SOURCE – any injury that you are unsure of how the resident received the injury. If you find a resident is injured, you must report it.


    MANDATORY REPORTER – all those who work in a healthcare facility must report any reasonable suspicion of abuse of a patient/resident to the facility administrator and state agency responsible for handling these types of reports. 

     

    PATIENT-RESIDENTS’ RIGHTS; ABUSE-NEGLECT AND THE ELDER JUSTICE ACT INSERVICE


    Any employee guilty of abusing a patient/resident is subject to immediate discharge. Local and State Authorities will be notified immediately, and criminal charges may be filed against any employee guilty of abuse.


    If you see or hear of any form of Patient /Resident Abuse You Must Report It immediately to the Facility Admin/DON and Live Well Human Resources Department.
    Email : hr@livewhs.com or HR Hotline #203-580-5690 Ext. 1

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  • Stop & Watch In-Service

  • Purpose: It is important for all employees who may come in contact with residents while performing their duties to be aware of the types of behavior that could indicate a serious change in a resident’s health. This is important for employees who may provide direct patient care as well as those who do not provide direct patient care, like most dining and all environmental services employees, as all employees may interact with residents daily.


    It is important that if you notice one of these types of changes that you immediately notify a member of the nursing staff. The facility may have a form for you to complete if you notice a change in a resident’s behavior, but the important thing is that you report the change to nursing, so they are aware.


    The types of changes that could indicate a serious change in a resident’s health could include:


    ► If they seem different than usual – For example, if a resident who is usually friendly seems angry, sad, or upset for no obvious reason


    ► If they talk or communicate less – If you notice that a resident is not talking as they usually do, for example, if a resident who is usually very talkative is quiet or unresponsive when you say “good morning” or “how are you today”


    ► If they seem more agitated or nervous than usual – For example, a resident who is usually calm appears nervous, upset, or anxious for no obvious reason


    ► If the resident seems more tired, weak, confused, or drowsy than usual – For example, a resident who is usually clear-headed seems to be confused about where they are, or, if a resident who is usually active and independent is too weak to walk or stand.


    Dining Services employees may notice:


    ► That food is left on the tray, which indicates that a resident is eating less lately than they usually do, even when served their favorite foods.


    ► That a beverage is returned, indicating the resident is drinking less than they usually do, and it’s not because the resident dislikes the beverage.


    If you notice any of these changes report it to nursing immediately.


    Some facilities may have specific forms for you to use to report these changes in mood, speech, alertness, coordination or appetite. Remember that the important thing is that you immediately report these changes to a member of the nursing staff, then inform your immediate su

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  • PART 2 OF 4 COMPLETE

    Click NEXT below to continue to part 3

  • Form 8850

    Part 3 of 4
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  • This company participates in various federal and state tax credit programs. This information in no way will negatively impact any hiring, retention decision. Your responses to the questions will only be shared with your employer's management and federal, state, or local govern mental agencies as needed in administration of these 5 programs. By completing this form, you knowingly and voluntarily waive any objection to providing your social security number. Any information provided will be used in a manner consistent with the American Disablity Act. Under penalty of perjury, I certify that this information is true and correct to the best of my knowledge. I hereby authorize this company's management, and federal, state, and local government agencies to provide information to Tax Oppurtunities America and/or SWA, to determine eligibility. I understand that the information above may be subject to verification.

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  •  / /
  • I affirm that one of more of the below categories applies to me:

    • I am pregnant or a parent of a child
    • I am over 18 and do not have a high school diploma of GED/HSE diploma
    • I am a member of a family that is receiving assitance from Temporary Assistance for Needy Families (TANF).
    • I am a member of a family that is receiving SNAP benefits (food stamps).
    • I am a member of a family that is receiving SSI benefits.
    • I am receiving a free reduced-cost school lunch
    • I have served in jail or prison, or am on probation or parole.
    • I am currently or was in foster care of the custody of the Office of Children and Family Services.
    • I am a veteran.
    • I am the daughter or son of a parent who is currently in jail or prison, or has been within in the past two years.
    • I am the daughter or son of a parent who is collecting unemployment insurance.
    • I live in public housing or receive housing assistance such as a Section 8 voucher, or am homeless.
    • I consider myself to have a different risk factor not identified in the above list.

     

    Agreement

    I affirm that I currently meet the qualifications listed above in the New York Youth Jobs Program: Youth Certifcation Qualifcations section. I have provided my private information on this application. While I need to disclose this information to qualify for the program, I understand that I do not need to explain the reasons I choose to anyone I ask for a job, who gives me a job, or who I work with. I agree to allow the New York State Department of Taxation and Finance to share my wage records with the New York State Department of Labor. I understand that the New York State Department of Labor will make sure the information submitted in this application is true and may ask me for details. I believe this information is correct and complete. I am aware that there are consequences for filing false documents or other information with the government.

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  • PART 3 OF 4 COMPLETE

    Click NEXT below to continue to part 4

  • Form I-9, Form W-4, & State Tax Forms

    Part 4 of 4
  • USCIS Form I-9

  • I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or Immigration status, is true and correct.

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  • If you check Item Number 4. enter one of these:

  • OR

  • OR

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  • Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 of Form I-9.

     

    I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

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  • Image-491
  • Form W-4 - Employee's Withholding Certificate

  • Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, and when to use the estimator at www.irs.gov/W4App.

  • Step 2: Multiple Jobs or Spouse Works

     

    Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all these jobs.

    Do only one of the following.

    (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3-4). If you or your spouse have self-employment income, use this option; or

    (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or

     

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  • Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job.)

  • Step 3: Claim Dependent and Other Credits

     

     

    If your total income will be $200,000 or less ($400,000 or less if married filing jointly): 

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  • AR4EC

    State of Arkansas Employee's Withholding Exemption Certificate
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  • Form CT-W4

    State of Connecticut Employee's Withholding Certificate
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  • DE-W4

    State of Delaware Employee's Withholding Allowance Certificate
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  • NJ-W4

    State of New Jersey Employee's Withholding Allowance Certificate
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  • K-4

    State of Kansas Employee's Withholding Allowance Certificate
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  • A) Allowance Rate:

    If you are a single filer mark "Single".

    If you are married and your spouse had income mark "Single".

    If you are married and your spouse does not work mark "Joint".

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  • Form M-4

    State of Massachusetts Employee's Withholding Exemption Certificate
  • Employee:

    File this form with your employer. Otherwise, Massachusetts Income Taxes will be witheld from your wages withhout exemption.

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  • Mississippi Employee's Withholding Exemption Certificate

  • Image-748
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  • Ohio IT 4

    State of Ohio Employee's Withholding Exemption Form
  • Section 1: Personal Information

  • Section 2: Claiming Withholding Exemptions

  • Section 3: Withholding Waiver

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  • Pennsylvania Residency Certification Form

    Local Earned Income Tax Withholding
  • Use the Address Search Application at dced.pa.gov/Act32 to determine PSD codes, EIT rates,and tax collector contact information.

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  • RI W-4

    State of Rhode Island Division of Taxation - Employee's Withholding Allowance Certificate
  • Federal Form W-4 can no longer be used for Rhode Island withholding purposes. You must complete Form RI W-4 for your employer(s). Once you have completed Form RI W-4 for your employer, Form RI W-4 only needs to be completed if you are making changes to your withholding allowance or have a new employer. Form RI W-4 must be completed each year if you claim "EXEMPT" or "EXEMPT-MS" on line 3 below.

    If you have more than one job or your spouse works, you should figure the total number of allowances you are entitled to claim. Your withholding usually will be more accuarate if you claim all your allowances on the Form RI W-4 for the highest-paying job and claim zero on all your other RI W-4 forms. You may reduce the number of allowances or request that your employer withhold an additional amount from your pay, which may help avoid having too little tax withheld. Also, keep in mind that if youar annual wages exceed $241,850, your exemption amount will be phased our and be equal to zero.  

     

    Line 1: Figure your personal allowance (including allowances for dependents)

  • Exempt Status #1

    If you meet both of the conditions below, you may claim exemption from Rhode Island withholding:

    1. Last year I had a right to a refund of all RHode Island income tax withheld because I had no tax liability AND
    2. This year I expect a refund of all Rhode Isalnd income tax because I expect to have no tax liability.

    If you meet both of the above conditiona, write "EXEMPT" on line 3 below.

     

    Exempt Status #2

    If you are the spouse of a servicemember stationed in Rhode Island, your wage may be exempt under the Military Spouses Residency Relief Act. If you meet both of the conditions below, you may claim exemption from Rhode Island withholding.

    1. You moved to Rhode Island soley to be with your servicemember spouse in compliance with military orders sending the servicemember to Rhode Island AND
    2. You have the same non-Rhode Island domicile as your servicemember spouse.

    If you meet both of the above conditiona, write "EXEMPT-MS" on line 3 below.

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  • Form VA-4

    Employee's Virginia Income Tax Withholding Exemption Form
  • 5) Exemptions for age

  • 6) Exemptions for blindness

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  • WV IT-104

    West Virginia Employee's Withholding Exemption Certificate
  • Complete this form and present it to your employer to avoid any delay in adjusting the amount of state income tax to be withheld from your wages.

    If you do not complete this form, the amount of tax that is now being withheld from your pay may not be sufficient to cover the total amount of tax due the state when filing your personal income tax return after the close of the year. You may be subject to a penalty on tax owed the state.

    Individuals are permitted a maximum of one exemption for themselves, plus an additional exemption for their spouse and any dependent other than their spouse that they expect to claim on their tax return.

    If you are married and both you and your spouse work and you file a joint income tax return, or if you are working two or more jobs, the revised withholding tables should result in a more accurate amount of tax being withheld.

    If you are Single, Head of Household, or Married and your spouse does not work, and you are receiving wages from only one job, and you wish to have your tax withheld at a lower rate, you must check the box in line 5.

    When requesting withholding from pension and annuity payments you must present this completed form to the payor. Enter the amount you want witheld on line 6.

    If you determine the amount of tax being withheld is insufficient, you may reduce the number of exemptions you are claiming or request additional taxes be withheld from each payroll period. Enter the additional amount you want to have withheld on line 6.

    Employees who reside in Kentucky, Maryland, Ohio, Pennsylvania, Virginia or who are a Military Spouse exempt from income tax on wages, see page 2.

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  • WV IT-104NR

    West Virginia Certificate of Nonresidence
  • If you are a resident of Kentucky, Maryland, Ohio, Pennsylvania or Virginia and your only source of income from West Virginia is wages or salaries, you are exempt from West Virginia Personal Income Tax Withholding. Upon receipt of this form, properly completed, your employer is authorized to discontinue the withholding of West Virginia Income Tax from your wages or salaries earned in West Virginia.

    If you are a miltary spouse and (a) your spouse is a member of the armed forces present in West Virginia in compliance with military orders; (b) you are present in West Virginia solely to be with your spouse; and (c) you maintain your domicile in another State and you are claiming exemption under the Servicemember Civil Relief Act, enter the state of your domicile (legal residence) on the follow statetment and attach a copy of your spousal military identification card.

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  • I certify that I am a legal resident of the State of * and am not subject to West Virginia withholding because I meet the requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Relief Act.

  • I hereby certify, under penalties provided by law, that I am not a resident of West Virginia, that I reside in the State of   *    and live at the address shown on this certificate, and request is hereby made to my employer NOT to withhold West Virginia income tax from wages paid to me. If at any time hereafter I become a resident of West Virginia, or otherwise lose my status of being exempt from West Virginia withholding taxes, I will properly notify my employer of such fact within ten (10) days from the date of change so that my employer may then withhold West Virginia income tax from my wages.

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  • NC-4

    North Carolina Employee's Withholding Allowance Certificate
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  • Maryland Form MW507

    Employee's Maryland Withholding Exemption Certificate
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  • 8) I certify that I am a legal resident of the State of and am not subject to Maryland withholding because I meet the requirements set forth under the Servicemembers Civil Relief Act, as amended by the Military Spouses Residency Act.   

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  • New York State Form IT-2104

    Employee's New York State Withholding Allowance Certificate
  • Before making any entries, see the Note below, and if applicable, complete the worksheet in the instructions.

  • Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.

  • I certify that I am entitled to the number of withholding allowances on this certificate.

     

    Penalty - A penalty of $500 may be imposed for any false statement you make that decreases the amount of money you have withheld from your wages. You may also be subject to criminal penalties.

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  • Note: Single taxpayers with one job and zero dependents, enter 1 on lines 1 and 2 (if applicable). Married taxpayers with or without dependents, heads of household or taxpayers that expect to itemize deductions or claim tax credits, or both, complete the worksheet in the instuctions. Visit www.tax.ny.gov (search: IT-2104-1).

  • PART 4 OF 4 COMPLETE

    Click SUBMIT below to complete the Onboarding Packet.

    A copy of the Live Well Employee Handbook and the Beneifts Booklet will be emailed to the following email address which you provided: {emailAddress}

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