Ohio Employer/Employee Agreement

Ohio Employer/Employee Agreement

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
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Ohio 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
Case Manager Information
Case Manager Legal Name*

First NameLast Name
Case Manager 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 employer.*
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 Ohio.*
I will complete and keep current any individualized training recommended by the Participant/Employer and/or the State of Ohio.*
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 Catholic Social Services 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.*
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 working in the ComCare services 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*

Clear
Date of Signature*

MonthDayYear
Date
Employer Legal Name*

First NameLast Name
Employer Signature*

Clear
Date of Signature*

MonthDayYear
Date
Case Manager Legal Name*

First NameLast Name
Case Manager Signature*

Clear
Date of Signature*

MonthDayYear
Date
Should be Empty:

Ohio Employer/Employee Agreement

Ohio Employer/Employee Agreement

Employer Information

Participant Information

Employee Information

Case Manager Information

Initials

Signatures