Prototype - Ohio Rate Information Form

Ohio Rate Information Form

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
Step 1 - EmployeeStep 2 - EmployerStep 3 - Case ManagerI need to print the form
Click the print icon in the top right corner to print.

Ohio Rate Information Form

For questions, please contact Morning Sun Financial Services at 1-844-450-5444
The Employer/Participant must approve this completed form before Morning Sun can enter your employees pay rate.
Participant Legal Name*

Legal First NameLegal Last Name
Employee Legal Name*

Legal First NameLegal Last Name
Employee Email*
example@example.com
Case Manager Legal Name*

Legal First NameLegal Last Name
Case Manager Email*
example@example.com
Employer Legal Name*

Legal First NameLegal Last Name
Employer Email*
example@example.com
What type of employee does this apply to?*
New Employee rate of pay per hour*
Effective Date*

MonthDayYear
Date
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*

Legal First NameLegal Last Name
Employee Signature*

Clear
Date of Signature*

MonthDayYear
Date
Employer Legal Name*

Legal First NameLegal Last Name
Employer Signature*

Clear
Date of Signature*

MonthDayYear
Date
Case Manager Legal Name*

Legal First NameLegal Last Name
Case Manager Signature*

Clear
Date of Signature*

MonthDayYear
Date
Should be Empty:

Ohio Rate Information Form