ARIS Solutions Employee Packet Form – Fill Out and Use This PDF

ARIS SOLUTIONS

CHOICES FOR CARE and PARTICIPANT DIRECTED ATTENDANT CARE

EMPLOYEE HIRING PACKET

Please assure that all highlighted areas on each form are completed. Employers must complete areas highlighted in pink. Employees must complete areas highlighted in yellow. ARIS Solutions must return any hiring packet which is not complete to the Employer. Employee paychecks cannot be processed until the packet is returned with all highlighted areas complete.

ALL STARRED (*) FORMS MUST BE COMPLETED AND RETURNED TO ARIS SOLUTIONS

Employee Hiring Notice *

Employee Compliance with Agency of Human Services Background Check Policy *

W-4 and Vermont W-4 Withholding Tax Forms *

Employment Eligibility Verification Form *

Important Note: Employers must look at the Employee’s forms of Identification Documentation and must write that information directly on this form. Photo copies of identification information do not take the place of the employer looking at and writing down this information on the form.

Important information for all Employees *

Employees must review this document and sign the certification page.

Agency of Human Services Adult Protection Services and Child Abuse Registry Check*

Request for Criminal Information Check *

Vermont Driver Information Check * (No need to send payment)

If your employee will not be driving as part of his/her job, please write “will not be driving” across this form.

Direct Deposit Form

Pay Schedule – Please keep this schedule for your reference.

MAIL COMPLETED PACKET TO:

ARIS SOLUTIONS

P0 BOX 4409

WHITE RIVER JUNCTION, VT. 05001

1-800-798-1658

Employers may verify that ARIS Solutions has received the Employee Hiring Packet by calling our office

and speaking with a Payroll Support Specialist.

Please call ARIS Solutions with any questions you may have when completing these forms. Additional forms may be obtained by calling ARIS Solutions or by going to our website at:

w w w .arissolut ions.org

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FORMS TO BE COMPLETED WHEN HIRING AN EMPLOYEE

All forms are color highlighted for your convenience. Pink highlighted areas are to be completed by the employer. All yellow highlighted areas are to be completed by the employee. Please be sure that all highlighted areas are completed.

Employee Hiring Notice - This form is to be completed by the employer. It tells ARIS Solutions who you are hiring, what the employee’s address is for mailing paychecks, along with their Social Security number. The employer signs this form to authorize hiring the employee.

Employee Compliance with Agency of Human Services Background Check Policy This form must be reviewed and signed by the employee. Employees having convictions or findings as indicated on the form may not be paid by ARIS Solutions to provide services.

Forms W-4 and W-4 VT - These forms are completed by the employee. The forms are required as they provide specific tax withholding information for each employee.

Employment Eligibility Verification - This form is required by the Department of Justice. The purpose of the form is to assure the Dept. of Justice that the person being hired is legally able to work in the United States. The employer must look at the original identification information (see List of Acceptable Documents) and write this information down directly on the form. It is not necessary to send in photo copies of the identification documents. The employee fills out and signs the top yellow highlighted section of the form. The employer fills out and signs the middle pink highlighted section of the form.

Background Check Forms - All employees are required by the State of Vermont to have background checks completed whenever working for a new employer. These background checks must be filled out by the employee and signed by the employee. They include a check of the Vermont Adult Abuse and Child Abuse Registries, the Vermont Crime Information Center along with the Department of Motor Vehicles. All forms must be submitted when hiring an employee. If your employee will not be driving while working please indicate this in writing directly on the DMV form. The employer will be notified in writing once all background checks have been completed. Please be aware that background checks are run for Vermont findings, only. Background checks provided by ARIS Solutions will not result in notification of criminal convictions or abuse substantiations founded in any state other than Vermont. Employers may choose to go online to conduct their own independent background checks at their own cost.

Direct Deposit Form - This is an optional form. We strongly encourage employees to use Direct Deposit to receive their pay. This eliminates any possible delays in the mail and assures that funds are automatically deposited into the employees account on payday. It may take up to two payroll periods for the Direct Deposit process to take place. Regular checks will be mailed to employees until the Direct Deposit account information is secured in our system.

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CHOI CES FOR CARE

PARTI CI PANT DI RECTED ATTENDANT CARE SERVI CES

REASONS FOR NON- PAYMENT OF EMPLOYEE TI MESHEETS

On occasion it may be necessary for ARI S Solutions to return employee timesheets to employers. This may result in employee paychecks being delayed. ARI S Solutions will attempt to contact employers by telephone to discuss timesheet errors or omissions whenever possible. ARI S Solutions is unable to process any timesheet which does not have the original signatures* of both the employer and the employee.

Reasons for non- payment of employee timesheets:

Absence of employee name or consumer name

Lack of I n and Out times or note of AM or PM hours (employees who reside with a consumer may write “ Live I n” as long as there are no other care providers)

Absence of employee or employer signature *

Lack of indication as to whether hours provided are for Personal Care, Respite or Companionship (CFC only, not for Flexible Choices or PDAC)

Missing dates of service

Photocopied or faxed employee or employer signatures on timesheets or packets cannot be accepted*

Lack of approved Service Plan

Patient Share (when applicable) has not been paid.

Submission of duplicate dates and hours of service

ARI S Solutions Payroll Support Staff call employers at least one time each payroll week to obtain missing information (* with the exception of missing signatures or photo copied forms) . I f the employer cannot be reached or does not return our call with the needed information, timesheets will be returned to the employer.

Additional causes for an employee not to receive a paycheck:

Late time sheets. Time sheets must be received in the ARI S Solutions office no later than Monday of each pay week, according to the Payroll Schedule.

Lack of or incomplete Employer enrollment forms.

Lack of or incomplete Employee enrollment forms.

Should a timesheet be returned to the employer for one of the above reasons, the employer should complete or correct the identified error, and re-submit the timesheet to ARI S Solutions. The timesheet will be processed and paid in the next pay period

following receipt in the ARI S Solutions office.

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ARIS SOLUTIONS

CHOICES FOR CARE/PDAC

EMPLOYEE HIRING NOTICE

EMPLOYEE NAME:______________________CONSUMER NAME: _________________

(This is the person who provides the care) (This is the person who receives the care)

EMPLOYEE MAILING ADDRESS:______________________________________________

CITY:_______________________________ STATE:______________ ZIP CODE:________

TELEPHONE NUMBER:_______________________________________________________

EMPLOYEE SOCIAL SECURITY NUMBER: _____________________________

WORK START DATE:_________________________________________________________

I,______________________________(employee), confirm that I am 18 years of age or older, have

completed high school or have a GED, and that I am not the legal guardian of the individual I am providing supports for.



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

EMPLOYER NAME:___________________________________________________________

EMPLOYER ADDRESS:________________________________________________________

______________________________________________________________________________

EMPLOYER SIGNATURE:_____________________________________________________

PLEASE BE SURE ALL HIGHLIGHTED AREAS ARE COMPLETED USING BLUE OR BLACK INK

IMPORTANT NOTE:

EMPLOYEES MUST BE 18 YEARS OF AGE OR OLDER

EMPLOYEEE MUST HAVE A HIGH SCHOOL DIPLOMA OR GED

EMPLOYEES MAY NOT BE LEGAL GUARDIANS

EMPLOYERS/SURROGATES MAY NOT BE PAID TO PROVIDE SERVICES

PLEASE NOTIFY ARIS SOLUTIONS IN WRITING WHEN AN EMPLOYEE IS TERMINATED FROM EMPLOYMENT

PLEASE NOTIFY ARIS SOLUTIONS IN WRITING IMMEDIATELY IF AN EMPLOYEE

HAS A CHANGE IN ADDRESS OR A NAME CHANGE. NAME CHANGES MUST BE ACCOMPANIED BY A COPY OF A SOCIAL SECURITY CARD DOCUMENTING THE

NEW NAME	9/11
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Employee Compliance with State of Vermont

Agency of Human Services

Background Check Policy

I, __________________________________, employee, have reviewed the State of Vermont, Agency

of Human Services Background Check Exclusions below and confirm that I do not have any convictions, substantiations or findings as outlined from this Policy which exclude me from being paid to provide supports under the State of Vermont Consumer Directed programs funded by DAIL and/or Medicaid.

I understand that ARIS Solutions will conduct background checks for me on behalf of my employer. I further understand that should any excluding conviction, substantiation or finding be identified as a result of these background checks that ARIS Solutions will be unable to process any further payroll for me effective the date of that finding.

_________________________________			__________________		OR
Employee			Date

I, __________________________ do have findings as outlined in the Policy. My employer

will be requesting a waiver of this policy from DAIL. I understand that unless a waiver is approved by DAIL that I will not be paid for any services I provide.

******************************************************************************

“Funds administered by DAIL (including Medicaid) may not be used to employ, place or contract with a person who has:

a.A substantiated record of abuse, neglect, or exploitation of a child or a vulnerable adult;

b.Been excluded from participation in Medicaid or Medicare services, programs, or facilities by the federal Department of Health and Human Services’ Office of the Inspector General; and/or,

c.A criminal conviction for an offense involving bodily injury, abuse of a vulnerable person, a felony drug offense, or a property/money crime involving violation of a position of trust, including, but not limited to:

Aggravated assault	Hate motivated crime
Aggravated stalking	Kidnapping
Aggravated sexual assault	Lewd and lascivious conduct
Assault and robbery	Simple assault
Manslaughter	Sexual assault
Assault upon law enforcement	Murder
Cruelty to children	Domestic assault
Arson	Stalking
Extortion	Embezzlement
Abuse, neglect, or exploitation	Recklessly endangering another
of a vulnerable adult or child	person while driving”
Cruelty to Animals	#5
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Form W-4 (2011)	Page 2
Deductions and Adjustments Worksheet
Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.

1Enter an estimate of your 2011 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 7.5% of your income, and

	miscellaneous deductions			1	$
	Enter: {	$11,600 if married filing jointly or qualifying widow(er)	}
2		$8,500 if head of household		2	$
		$5,800 if single or married filing separately
3	Subtract line 2 from line 1. If zero or less, enter “-0-”			3	$
4	Enter an estimate of your 2011 adjustments to income and any additional standard deduction (see Pub. 919)			4	$

5Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to

	Withholding Allowances for 2011 Form W-4 Worksheet in Pub. 919.)	5	$
6	Enter an estimate of your 2011 nonwage income (such as dividends or interest)	6	$
7	Subtract line 6 from line 5. If zero or less, enter “-0-”	7	$
8	Divide the amount on line 7 by $3,700 and enter the result here. Drop any fraction	8
9	Enter the number from the Personal Allowances Worksheet, line H, page 1	9

10Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet,

also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1

10

Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)

Note. Use this worksheet only if the instructions under line H on page 1 direct you here.
1	Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)	1

2Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more

than “3”

2

3If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter

“-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet

3

Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional

	withholding amount necessary to avoid a year-end tax bill.
4	Enter the number from line 2 of this worksheet	4
5	Enter the number from line 1 of this worksheet	5
6	Subtract line 5 from line 4			6
7	Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . .			7	$
8	Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . .			8	$

9Divide line 8 by the number of pay periods remaining in 2011. For example, divide by 26 if you are paid every two weeks and you complete this form in December 2010. Enter the result here and on Form W-4,

line 6, page 1. This is the additional amount to be withheld from each paycheck . . . . . . . . 9 $

					Table 1										Table 2
Married Filing Jointly								All Others				Married Filing Jointly						All Others
If wages from LOWEST					Enter on	If wages from LOWEST					Enter on	If wages from HIGHEST			Enter on	If wages from HIGHEST				Enter on
paying job are—					line 2 above	paying job are—					line 2 above	paying job are—			line 7 above	paying job are—				line 7 above
$0	- $5,000 -				0	$0 - $8,000 -					0	$0 - $65,000			$560	$0 - $35,000				$560
5,001	-	12,000	-		1	8,001	-	15,000	-		1	65,001	-	125,000	930	35,001	-	90,000		930
12,001	-	22,000	-		2	15,001	-	25,000	-		2	125,001	-	185,000	1,040	90,001	-	165,000		1,040
22,001	-	25,000	-		3	25,001	-	30,000	-		3	185,001	-	335,000	1,220	165,001	-	370,000		1,220
25,001	- 30,000 -				4	30,001	- 40,000 -				4	335,001 and over			1,300	370,001 and over				1,300
30,001	-	40,000	-		5	40,001	-	50,000	-		5
40,001	-	48,000	-		6	50,001	-	65,000	-		6
48,001	-	55,000	-		7	65,001	-	80,000	-		7
55,001	-	65,000	-		8	80,001	-	95,000	-		8
65,001	-	72,000	-		9	95,001	-120,000		-		9
72,001	- 85,000 -				10	120,001 and over					10
85,001	-	97,000	-		11
97,001	-110,000		-		12
110,001	-120,000 -				13
120,001	-135,000 -				14
135,001 and over					15
Privacy Act and Paperwork					Reduction Act Notice. We ask for the information on this form to							You are not required to provide the information requested on a form that is
carry out the Internal Revenue laws of the United States. Internal Revenue Code sections												subject to the Paperwork Reduction Act unless the form displays a valid OMB
3402(f)(2) and 6109 and their regulations require you to provide this information; your employer												control number. Books or records relating to a form or its instructions must be
uses it to determine your federal income tax withholding. Failure to provide a properly												retained as long as their contents may become material in the administration of
completed form will result in your being treated as a single person who claims no withholding												any Internal Revenue law. Generally, tax returns and return information are
allowances; providing fraudulent information may subject you to penalties. Routine uses of this												confidential, as required by Code section 6103.
information include giving it to the Department of Justice for civil and criminal litigation, to												The average time and expenses required to complete and file this form will vary

	cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in	depending on individual circumstances. For estimated averages, see the
	administering their tax laws; and to the Department of Health and Human Services for use in
		instructions for your income tax return.
	the National Directory of New Hires. We may also disclose this information to other countries
		If you have suggestions for making this form simpler, we would be happy to hear
	under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to
		from you. See the instructions for your income tax return.
	federal law enforcement and intelligence agencies to combat terrorism.

Instructions for completing Form W-4VT

Who must complete Form W-4VT:

Any person whose employer requires this form. ( State Employees MUST Complete This Form)

Any person requiring Vermont withholding to be based on W-4 information which is different from the federal W-4. This would include employees anticipating Child Tax Credit, Hope Credit, or other federal credits which do not pass through to Vermont income tax and employees who are in civil unions.

Completing Form W-4VT: This form is completed in the same manner as the federal W-4. Complete the federal form first, following the instructions on the form or IRS publication 919, How Do I Adjust My Tax Withholding?.

Parts 1 and 2: Print clearly or type your Name and Social Security Number.

Part 3: Enter any information required by your employer.

Part 4: a. If you are a partner in a civil union, check either “Civil Union” or “Civil Union, but withhold at the higher single rate”. Otherwise, check the filing status used on the Federal W-4.

b. Enter the number of withholding allowances for Vermont withholding. If you claimed additional allowances for Federal tax because of an anticipated child credit or education credit, do not claim these additional allowances for Vermont withholding.

c.If you want an additional amount of Vermont withholding to be deducted from each paycheck, enter that amount.

Part 5: Sign and date the form and return it to your employer.

This form may be photocopied as needed

______________________________________________________________________________________________________

	W-4VT				State of Vermont Department of Taxes
				Vermont Employee’s Withholding Allowance Certificate
	Part 1						Part
							2
			First Name	Initial	Last Name				Social Security Number
	Part 3		Employee Number: ____________________________
			(or other employer information required by employer)

a.Is your Vermont filing status:

		Single	Married	Married, but withhold at the higher Single Rate
	Part 4		Civil Union	Civil Union, but withhold at the higher Single Rate

b.Total number of Vermont Withholding allowances ………………………………………b.

c. Additional amount, if any, of Vermont tax to be withheld from each paycheck…………c. $

I certify that I am entitled to the number to withholding allowances claimed on this certificate.

Part 5

Signature

Date

ATTENTION!

Important information regarding the

Employment Eligibility Verification Form

One of the most common causes of returned employee hiring packets is that the Employment Eligibility Verification Form incomplete or incorrectly completed. To help with this we ask that both the Employer and the Employee complete this checklist together to ensure that the following items are complete on the form.

Incomplete packets must be returned to the employer. This slows down the enrollment process for employees and often delays paychecks for employees. Please be sure that this form is completed as required.

Make sure the Employee has completed the following:

□Name and address

□Date of Birth

□Social Security number

□Citizen Status (check one)

□Signature and date

Make sure the Employer has completed the following:

□Written down the identification information and numbers from the forms of identification given by the employee (i.e. license number, social security number, etc.). Please refer to list of acceptable documents.

Note: One form of ID is needed if using list A. Or, two forms of documents are needed; one from list B and one from list C.

□Written down the expiration date for any document with an expiration date.

□Written in the date under “Documentation Certification”

□Signed and printed their name.

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11.Are there other reasons paychecks may not be issued to employees?

Yes. Please see attachment “Causes for Non-Payment of

Timesheets” in your hiring packet. Please be reminded that the employer is responsible to assure that all timesheets are signed, complete and are submitted by them in accordance with the payroll schedule. Additionally, the employer is responsible to assure that funds or hours are available to cover the payroll.

PLEASE SI GN THE ATTACHED FORM I NDI CATI NG THAT YOU HAVE READ

THI S I NFORMATI ON

The signed form must be returned to ARI S Solutions w ith your hiring packet .

Please keep t he information sheet s for your records.

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3

Confirmation of Receipt of

Important Information for All Employees

I, ____________________________, employee for ________________________

have received and reviewed the Important Information for All Employees document.

______________________________		____________________
Employee		Date

This form must be returned with the employee hiring packet. Employees cannot be paid until this form has been returned to ARIS Solutions.

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4

ARIS SOLUTIONS

ISO

CONSENT FOR RELEASE OF INFORMATION

REQUEST FOR VERMONT CRIMINAL RECORD CHECK

It is important to put your FULL, LEGAL name

1.Employee: ________________________________________________________

Last

First

Middle

2.Maiden or Alias Names:_____________________________________________

3.Social Security Number_________/_________/___________

4.Place of Birth____________________________/__________________

City or Town

State

5.Date of Birth____________/_________/___________

Month Day Year

6.Telephone Number_____________________________

RELEASE

I, _______________________________ herby acknowledge and agree to a check of any

criminal record of convictions which may be maintained by the Vermont Criminal Information Center. I understand that the results of that check will be made available to ARIS Solutions for use in reviewing my suitability as an employee to consumers. I further understand that I have the right to appeal the results of the criminal record check to the Vermont Criminal Information Center, Department of Public Safety, 103 South Main Street, Waterbury, VT, 05671.

Signature of Employee:______________________________________Date_______________

!"###$%&"'(%)**##!&+ !#!$