Staff Onboarding & Document Submission Form

Staff Onboarding & Document Submission Form

Please complete all required sections and upload necessary documents to start your employment process.
Personal Information
Full Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State / ZIP
Personal Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Personal Email Address
example@example.com
Emergency Contact
Emergency Contact Full Name

First NameLast Name
Relationship to Employee
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position Details
Position
Offer Date

MonthDayYear
Date
Expected Start Date

MonthDayYear
Date
Work Eligibility
Are you legally authorized to work in the US?
Will you require visa sponsorship now or in the future?
Required Document Uploads
Government-Issued Photo ID

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Social Security Card

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I-9 Employment Eligibility Verification

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Direct Deposit Form + Voided Check

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Signed I-9 Copy

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Signed W-4 Copy

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STEP 1 — LIVE SCAN FINGERPRINTING REQUIREMENT

All Open Grace LLC Family Coordinators are required
to complete a Live Scan fingerprint background check
before their official start date.

YOUR OPEN GRACE LIVE SCAN FORM IS READY

Your Request for Live Scan Service form (BCIA 8016)
has already been pre-filled with Open Grace LLC
agency information including:

[DOWNLOAD YOUR LIVE SCAN FORM clicking down below]

WHAT TO BRING TO YOUR APPOINTMENT
- This downloaded and printed Live Scan form
- Valid government-issued photo ID
- Payment (cash or card — varies by location,
typically $25–$75)

HOW TO FILL IN YOUR PERSONAL SECTION
Complete the Applicant Information section with:
- Your full legal name
- Date of birth
- Driver's license number
- Height, weight, eye and hair color
- Place of birth
- Social Security Number
- Your home address for receiving results

WHERE TO GO
Find your nearest Live Scan location:
https://oag.ca.gov/fingerprints/locations

Riverside area locations include:
- Riverside County Sheriff's Office
- UPS Store locations (many are authorized)
- Notary and fingerprinting service centers

AFTER YOUR APPOINTMENT
Upload your Live Scan receipt in the
field below. Processing typically takes
3–7 business days.

⚠️ You may begin orientation while awaiting
clearance but CANNOT have direct unsupervised
contact with clients until clearance is confirmed
by the Director.

Questions? Contact joshua.kennedy@opengrace.org
or call 909-561-4803
📋 Your Live Scan Form is Ready

This form has been pre-filled with Open Grace LLC agency information. Download, print, and bring it to your Live Scan appointment.
⬇️ Download Your Live Scan Form (BCIA 8016)
File opens in a new tab — print before your appointment
Live Scan Fingerprint Clearance Receipt

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CPR & First Aid Certification Resources

If you do not yet have a valid CPR/First Aid
certification, you must obtain one before your
start date. The following are approved providers, you may take an online CPR and First Aid, listed are a couple of providers:

American Red Cross
https://www.redcross.org/take-a-class

American Heart Association
https://www.heart.org/cpr

National CPR Foundation (Online + In-Person)
https://www.nationalcprfoundation.com

Certification must be:
- Current (not expired)
- From an accredited provider
- Include both CPR and First Aid
- Adult, Child, and Infant CPR preferred

Upload your certificate in the
CPR/First Aid upload field below.
CPR/First Aid Certification

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Resume/ Degrees

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Acknowledgments
Acknowledgments
Digital Signature
Full Legal Signature
Signature Date

MonthDayYear
Date
Signed Employee Handbook Acknowledgement Page

Download the signature page from the onboarding preparation page, sign it, and upload here.
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Signed Handbook Acknowledgment

Add Signed Handbook Acknowledgment - last page of the handbook. Available on onboarding dashboard.
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Program Compliance Acknowledgments
I have completed Mandated Reporter training and understand my reporting obligations.
I acknowledge Open Grace's HIPAA privacy practices and the confidentiality of client protected health information (PHI).
I understand client information must never be shared, copied, or stored outside approved Open Grace systems.
System Setup Confirmation
Microsoft Teams account set up and signed in?
Completed a practice contact-log submission in the Staff Portal?
Should be Empty:

Staff Onboarding & Document Submission Form

Personal Information

Emergency Contact

Position Details

Work Eligibility

Required Document Uploads

Acknowledgments

Digital Signature

Program Compliance Acknowledgments

System Setup Confirmation