Louisiana Self-Direction Option for Community Choices Waiver Employee Agreement

Louisiana Self-Direction Option for Community Choices Waiver Employee Agreement

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
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Louisiana Self-Direction Option for Community Choices Waiver Employee Agreement

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Please review the agreement
Employee Legal Name

First NameMiddle NameLast Name
Employee Email
example@example.com
Employer Legal Name

First NameLast Name
Employer Email
example@example.com
Participant Legal Name

First NameLast Name
Signatures

I understand and accept that my electronic signature will be as valid as a handwritten signature and considered original to the extent allowed by applicable law. Please see the Consumer Consent Disclosure at https://www.jotform.com/consumer-consent-disclosure/
My signature on this document verifies my acknowledgement and agreement to follow the policies and procedures of the Self-Direction option and policies and procedures of the program under which services are provided.
Employee Signature
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer Signature
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I have clicked "Preview PDF" and reviewed my form for accuracy
Please verify that you are human
Should be Empty:

Signatures