These forms are frequently used in the PCA/FI program. Northeast Arc FI Department reviews all forms posted here to ensure that they are the most up to date version available.

The forms are presented as a PDF (portable document format).  This will allow you to view and print the forms from a computer. 

Blank Forms for Hiring a Personal Care Assistant

For a COMPLETE PCA HIRE PACKAGE   Click here

 

 For individual forms select the form you wish to print below   

ENGLISH FORMS	FORMULARIOS EN ESPANOL
FORM I-9 Blank	FORMULARIO I-9
FORM I-9 Sample	EJEMPLO DE FORMULARIO I-9
FORM W-4 Blank	FORMULARIO W-4
FORM W-4 Sample	EJEMPLO FORMULARIO W-4
FORM M-4 Blank	FORMULARIO M-4
FORM M-4 Sample	EJEMPLO FORMULARIO M-4
DIRECT DEPOSIT FORM	FORMULARIO DE DEPOSITO DIRECTO
1199SEIU Membership Application	1199SEIU Aplicacion para membresia
FORM 2678 Employer/Payer Appointment of Agent
FORM 2848 Power of Attorney & Declaration of Representative
FORM 8821 Tax Information Authorization

 

Employer / Consumer Forms  

ENGLISH FORMS	FORMULARIOS EN ESPANOL
Payroll Calendar 2012 A-L	Horario de Nomina 2012 A-L
Payroll Calendar 2012 M-Z	Horario de Nomina 2012 M-Z
Time sheet Instructions	Instrucciones para hojas de tiempo
Stop Payment Request Form	Solicitud de paro de pago
PCA Termination Form	Forma de Terminación de empleo
PCA Termination Form Sample	Forma de Terminación de empleo Ejemplo
Reporting Problem when faxing a timesheet	Reporte de problemas mientras mandan las hojas de tiempo por fax
Change Request and Supply Request form	Solicitud de cambios y de formularios en blanco

 

General Employer/ Consumer Information  

ENGLISH FORMS	FORMULARIOS EN ESPANOL
Who can be employed as PCA?	Quien puede ser un PCA?
Workers Compensation Policy	Póliza de Compensación al Trabajador
Northeast Arc Grievance Policy	Póliza de quejas y reportes del NEARC
Northeast Arc Notice of Privacy Practices	Póliza de Practicas de privacidad del NEARC
Department of Industrial Accidents Notice to Employees	Notificación a empleados Departamento de Accidentes Industriales
How to file for Unemployment benefits?	Como aplicar para beneficios de desempleo?
FI Customer service contact list	Lista de contactos del Servicio al Cliente de FI
Holiday list	Lista de dias de fiestas