New Hire Forms

Our New Hire packet includes all the forms necessary to complete the setup process. The New Hire Packet can be downloaded by clicking on the link below. You can download the forms individually in the section below as well. More information about New Hires can be found below.

New Hire Packet
Form I-9

This form is required. It is the federal employment eligibility verification form. Please make sure you provide the correct, unexpired documents for section 2.

Form W-4 (English)

This form is required. Use it to submit your federal tax withholding.

Form W-4 (Spanish)

This is the Spanish version of the federal withholding form.

Form M-4

This form is required. Use this form to submit your income tax withholdings for Massachusetts

Direct Deposit Form

Direct Deposit is required for all PCAs. Please make sure a proof of account from your financial institution is included with this form.

Direct Deposit Instructions and Information

U.S. Bank Debit Card Application

U.S. Bank Overview Flyer

U.S. Bank Terms and Conditions Disclosure

PCA Signature Form

This form is required. Please make sure you check off your relationship to your consumer.

PCA Non-Covered Services Letter and Attestation

This form is required. This document outlines covered and non-covered services in the PCA program. Any non-covered services are not eligible for payment. This document also contains an attestation form that all newly hired PCAs must sign and submit with their new hire paperwork. The letter and attestation forms are in both English and Spanish.

New Hire Form

This is a cover sheet for your new hire paperwork. Please be sure to include the consumer number in the space provided.

PCA Job Description

This document outlines the job description for PCAs. Both English and Spanish versions are included in this .pdf.

PCA Union Membership Application

Please complete this form if you wish to become a member of the 1199SEIU.

Notification of Reinstatement of PCA Form

This form is for PCAs being rehired under a previous consumer.

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