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Employee Forms
You can either download the following forms or open them and print on your printer. You will need Adober Acrobat to view the PDF files. To download to your computer, right click and choose "Save As". To open and print, double click. Files will open in a separate window.
TIME SHEETS:
- Habilitation Time Sheet (PDF File)
- Respite Time Sheet (PDF File)
- Attendant Care Time Sheet (PDF File)
- Housekeeping Time Sheet (PDF File)
- Paid Sick Time Time Sheet (PDF File)
PROGRESS REPORTS:
- Habilitation Progress Report BLANK (PDF File) -
- Attendant Care Progress Report BLANK (PDF File - 2 Pages) -
- Sample of completed Attendant Care Progress Report (PDF File-2 pages)
- Medication Log - Must be completed if Employee Administers Medications during month to Client (PDF File)
- Guide to Administering Medications – Rules all employees must follow
INCIDENT REPORT - All Incidents must be reported within 24 hours to Affinity Family Care Office
- Incident
Report (PDF File)
- Guide to types of incidents that should be reported. It is mandatory all employees report incidents within 24 hours to Affinity Family Care
CHANGE OF INFORMATION FORM (Direct Deposit/Name/Address/Phone Number etc.)
EMPLOYMENT APPLICATION:
- Employment Application (PDF File)
TAX FORMS:
- 2020 A-4 – Arizona State Tax Withholding – (PDF File)
- 2020 W-4 - Federal Tax Withholding (PDF File)
- I-9 Form - Employment Eligibility Form (PDF File)
TRANSPORTATION RELEASES
NOTE: Employees may only transport in their private vehicles. Employees MAY NOT transport in client/family vehicles without expressed permission from Affinity Family Care.
- Transportation Release Form - EMPLOYEE (PDF File) (Required for all Affinity Family Care employees when transporting clients)
- Transportation Release Form - FULL (used when employee not EVER transporting client) - (PDF File)
MISCELLANEOUS FORMS:
- Reference Request Form (PDF File)
- Emergency
Contact Information - EMPLOYEES (PDF File)
- Employee Photography/Video/Stories/Other Release– (PDF File)
- Grievance Complaint Form (PDF File)
- Behavioral Assessment (PDF Doc)
- Administration of Medication Authorization Form – EMPLOYEES – (PDF File)
- Criminal Record Disclosure Form (PDF Doc)