**If you have any questions on how to complete this form, please ask your tax preparer.
can not be faxed, must be original
(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:
Life Patterns, Inc.
3300 SW 29th St. Suite 100
Topeka, KS 66614
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.