1.   Life Patterns Employment Application




2.   Federal Tax W-4 Form

               **If you have any questions on how to complete this form, please ask your tax preparer. 



3.   Kansas Tax K-4 Form




4.   I-9 Employment Eligibility Verification Form

                       can not be faxed, must be original



5.   KBI Records Check Request




6.   Adult Abuse and Neglect Central Registry Request




7.   Child Abuse and Neglect Central Registry Request




8.   Direct Deposit / Payroll Card Enrollment 



​9.  Employment Agreement




10.  Payroll Provider Agreement



11.  Direct Support Worker Data Sheet for Authenticare




12.  TA Waiver Training Checklist 

         (for use ONLY by employees of participants on the HCBS TA waiver)

LIST OF EMPLOYEE APPLICATION

SHEETS NEEDED FOR EACH WAIVER


You will find what paperwork (from the left

that you will need for each waiver

DIRECT SUPPORT WORKERS

APPLY HERE by printing, filling out, and returning the below employment forms:

If you already have a individual /family lined up to work for

If your name or address changes after being hired, please let us know:

Are you looking for a family/individual to work for:

Once you have been cleared to start working...
How to clock in, time corrections and about Authenticare.

*** These 11 forms are required for support workers that have an individual/family lined up to work for already. Click on each underlined form, print, fill out, and return to one of our Life Patterns, Inc. offices at:

Topeka:                     

           Life Patterns, Inc.

           3300 SW 29th St. Suite 100

           Topeka, KS 66614

Montezuma:

          Life Patterns, Inc

          PO Box 418 / 101 W Mexitli St

          Montezuma, KS 67867


​*** After all of the following forms are completed correctly and submitted to the Life Patterns, Inc. office, the worker MUST PASS ALL background checks before the Direct Support Worker may begin working.


*** Completed forms can be mailed, faxed or hand delivered. If faxing...DO NOT fax the I-9 form. We MUST have the original form.


*** Workers for TA, PD, TBI and FE waivers must be at least 18yrs of age. Workers for the IDD waiver may be at least 16yrs of age, except siblings must be at least 18yrs of age.

     If parent(s) or guardian of Individual who is over 18 and would like to be an employee, He/she must have written permission from a judge that there is no conflict of interest.