Prototype- Tennessee Employer/Employee Agreement

Tennessee Employer/Employee Agreement

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
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Tennessee Employer/Employee Agreement

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Employer Information
Employer Legal Name

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

First NameLast Name
Employee Information
Employee Legal Name

First NameMiddle NameLast Name
Employee Address

Street Address

Apartment or Unit Number

CityState

Zip Code
Employee Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employee Email
example@example.com
Initials
I understand that all required enrollment paperwork must be completed and processed before I can receive payment for services provided.
I understand that the Participant or Authorized Representative is my empoyer.
I agree not to accept compensation for service provided above and beyond the authorized rate that my Participant/Employer has on record with Morning Sun.
Under penalty of perjury. I declare that the statements on this form are true and correct to the best of my knowledge.
I recognize that my employment is dependent on my Participant/Employer's participation in the applicable state program in Tennessee.
I will complete and keep current any individualized training recommended by the Participant/Employer and/or the State of Tennessee.
I understand and acknowledge that any untruthful report of services provided in an attempt to obtain improper payment is subject to investigation as fraud.
I acknowledge that federal income tax withholding, Medicare, Social Security, and state income tax withholding (as applicable) shall be deducted from my wages per applicable laws.
I understand and acknowledge that work performed in excess of the authorized amount or service limitations will not be paid by the State of Tennessee or Morning Sun.
I understand and acknowledge that, should I be paid in excess of what is allowable by the program, it may be deducted from my future payment(s).
I agree to maintain confidential all information regarding the Participant/Employer, their Authorized Representative, if applicable, and his/her family.
I agree to immediately notify a person designated by the Participant/Employer of any medical emergencies, illness, and/or medical treatment.
I agree to immediately notify the appropriate authorities if I have suspicion of abuse or neglect of the Participant/Employer.
Wage
Service
By signing below, I acknowledge that I have read this Employer/Employee Agreement in its entirety. I understand that I must sign and submit this form as a condition of employment in this program and that I cannot begin workign in the TCAD program until this form is completed and returned to Morning Sun. By signing below, I further acknowledge that I understand what is being required of me, and agree to abide by its terms and conditions. I further understand and agree that violation of any of the terms and/or conditions of this agreement may result in termination of this agreement and payment for employment to any recipient of this program.
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/
Employee Legal Name

First NameLast Name
Employee Signature
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer Legal Name

First NameLast Name
Employer Signature
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Tennessee Employer/Employee Agreement

Tennessee Employer/Employee Agreement

Employer Information

Participant Information

Employee Information

Initials

Signatures