1. FMS Agreement
cannot be faxed, must be original.
3. Form 2678: Assigns Life Patterns as Agent
4. KS Business Tax Application Form: Application for employee state withholding
6. Workers Compensation Election
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*** The 5 forms below are the next step for a Family/Individual that would like Life Patterns, Inc to provide Financial Management Service for them.
Click on each underlined form, print and complete.
*** All of the following forms must be completed correctly and submitted to the Life Patterns, Inc. office. Jon Gerdel and/or Teri Goodrich like to meet with each Individual/Family at some point during the application process.
*** Completed forms can be mailed, faxed or hand delivered.
FIRST STEP to RECEIVE SERVICES from LIFE PATTERNS....filling out and returning the application forms below:
Once cleared by Life Patterns and your MCO to receive services,
you may hire worker(s) by having them APPLY HERE.
Then please CLICK HERE to learn how to clock in & out, time corrections and about Authenticare.
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OUTSIDE RESOURCE
www. RewardingWork.org/Kansas
for personal care and respite workers.
**NOTE that job candidates listed in the Kansas Personal Care Directory have NOT been screened in
any way and their backgrounds have NOT been checked. That will be your responsibility as an employer.