Forms

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Employer of Record Forms:

All forms listed below are required in order to participate in the Employee of Record program:

Background Check Release Form (PDF)

Child Waiver Employment Agreement (PDF)

DHS Clearance Form (to be filled out by employees who provide services for consumers under the age of 18 only) (PDF)

Direct Deposit (PDF)

Employer of Record Agreement (PDF)

Fiscal Intermediary authorized signatures (PDF)

Michigan W-4 (PDF)

W-9 Instructions (PDF)

Additional Forms:

2011 Payroll Pay Period Schedule (PDF)

Child Waiver Program Voucher (PDF)

CLS/EOR Time Sheet (PDF)

Employer of Record Fax Cover Sheet (PDF)

Mileage Log (PDF)

MORC Community Living Supports Log (PDF)

Respite Only Forms:

All forms listed below are required in order to participate in the Respite Only program:

Affidavit (PDF)

Background Check Release Form (PDF)

DHS Clearance Form (to be filled out by employees who provide services for consumers under the age of 18 only) (PDF)

Direct Deposit (PDF)

Respite Invoice (PDF)

Respite Provider Agreement (PDF)