Texas Quality One Medical Services New PCA Orientation and New Hire Paperwork 6-26-2026

Policy & Procedure Training
Attendant Name

First NameLast Name
Youtube
Name of client you are applying for if you have one
Signature. By signing below, you understand and agree to abide by everything within this orientation as a condition of employment.
Date

MonthDayYear
Date

PAYROLL DIRECT DEPOSIT FORM

We only pay through direct deposit
Name

First NameLast Name
Today's Date

MonthDayYear
Date
Select the type of account
Account Number
Routing Number
Name of Bank or Institution
Account Number
Routing Number
Name of Bank or Institution
Signature
Date

MonthDayYear
Date

Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services

USCISForm I-9OMB No. 1615-0047Expires 10/31/2022
START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,
during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an
employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the
documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1

(Employees must complete and sign Section 1 of Form I-9 no laterthan the first day of employment, but not before accepting a job offer.)
Name

First NameLast Name
Middle Initial
Other Last Names Used (if any)
Address

Street Address

Apt Number (if any)

CityState / Province

Postal / Zip Code
Date of Birth (mm/dd/yyyy)

MonthDayYear
Date
U.S. Social Security Number
Employee's E mail Address
example@example.com
Employee's Telephone Number
I attest, under penalty of perjury, that I am (check one of the following boxes):
If you are a lawful permanent resident enter your A Number or USCIS Number:
A noncitizen (other than Numbers 2 and 3 above) authorized to work until (expiration date, if applicable, mm/dd/yyyy):

MonthDayYear
Some aliens may write "N/A" in the expiration date field.
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An A Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
1. A Number/USCIS Number:
2. OR Form I 94 Admission Number:
3. OR Foreign Passport Number:
Country of Issuance:
Signature of Employee
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
If a preparer and/or translator assisted you in completeing Section 1, that person MUST complete the Preparer and/or Translator Certification.

Employee's Withholding Certificate. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

OMB No. 1545-0074
Click here to view paper form and instructions
Name

First NameLast Name
Middle Initial
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
Marital Status
Step 3: Claim Dependents

If your income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000
Multiply the number of other dependents by $500
Add the amounts above and enter the total here
Step 4 (optional): Other Adjustments
(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income
(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here
(c) Extra withholding. Enter any additional tax you want withheld each pay period
Employee's signature: Under penalty of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete. (This form is not valid unless you sign it.)
Date

MonthDayYear
Date
Should be Empty:

Policy & Procedure Training

PAYROLL DIRECT DEPOSIT FORM

Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services

Section 1

Individual Characteristics Form (ICF) Work Opportunity Tax Credit

Employee's Withholding Certificate. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

Step 3: Claim Dependents

Step 4 (optional): Other Adjustments