Northeast Arc Electronic – Fill Out and Use

Electronic Timesheets Agreement

FAX THIS FORM TO 978Ǧ750Ǧ3639 OR

MAIL TO: Northeast Arc FI, 6 Southside Rd,

Danvers, MA 01923

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Š‡ Ž‡…–”‘‹… ‹‡•Š‡‡–• ‘†—Ž‡ ‹•

™‡„Ǧ„ •‡† ‹–‡”ˆ …‡ –Š”‘—‰Š ™Š‹…Š ‘•—‡”•ǡ

I.

—””‘‰ –‡•ǡ ‡”•‘ Ž ”‡ ––‡† –•ǡ † ‹•… Ž –‡”‡†‹ ”› •– ˆˆ …  ”‡•’‡…–‹˜‡Ž› ˜‹‡™

About The Electronic Timesheets Module

”‡Ž‡˜ – –‹‡•Š‡‡– ‹ˆ‘” –‹‘Ǥ ††‹–‹‘ ŽŽ›ǡ ‘•—‡”• † –Š‡‹” —””‘‰ –‡•ǡ „—– ‘–

‡”•‘ Ž ”‡ ––‡† –•ǡ ™‹ŽŽ „‡ „Ž‡ –‘ ˜‹‡™ –Š‡‹” ”‹‘” —–Š‘”‹œ –‹‘ ‘—–• †

„Ǥ

—–‹Ž‹œ –‹‘Ǥ

‘•—‡”•ǡ —””‘‰ –‡• † ‡”•‘ Ž ”‡ ––‡† –• ™‹ŽŽ „‡ „Ž‡ –‘ —•‡ –Š‡ •›•–‡ –‘ „‘–Š

…Ǥ

•—„‹–

† ’’”‘˜‡ –‹‡•Š‡‡–• ‡Ž‡…–”‘‹… ŽŽ› ˆ‘” ’ ›‡– „› –Š‡ ‹•… Ž –‡”‡†‹ ”›Ǥ

‘•—‡” ‹• ‘– ”‡“—‹”‡† –‘ Š ˜‡

—””‘‰ –‡ ‹ ‘”†‡” –‘ —•‡ –Š‡ •›•–‡Ǥ —– ‹ … •‡•

™Š‡”‡

‘•—‡” †‘‡• Š ˜‡

—””‘‰ –‡ † –Š‡ ‘•—‡” ’’”‘˜‡• –Š‡ —””‘‰ –‡ –‘ Š ˜‡

……‡•• –‘ –Š‡ Ž‡…–”‘‹… ‹‡•Š‡‡–• —„‹••‹‘ –‡”ˆ …‡ǡ „‘–Š –Š‡ ‘•—‡” † Š‹•ȀŠ‡”

—””‘‰ –‡ ™‹ŽŽ Š ˜‡ ‹†‡–‹… Ž

„‹Ž‹–‹‡• –‘ ‡–‡” † ’’”‘˜‡ –‹‡•Š‡‡–• ˆ‘” ’ ›‡–Ǥ ˆ –Š‡

‘•—‡” †‘‡• ‘– ˆ‡‡Ž …‘ˆ‘”– „Ž‡ ™‹–Š –Š‡ ‡Ž‡…–”‘‹… ‹–‡”ˆ …‡ǡ –Š‡ —””‘‰ –‡ Š • –Š‡

„‹Ž‹–› –‘ Š †Ž‡ ŽŽ ‘ˆ –Š‡ ‘•—‡”ǯ• –‹‡•Š‡‡– •—„‹••‹‘ † ’’”‘˜ Ž ”‡•’‘•‹„‹Ž‹–‹‡•Ǥ

Consumer Name: ________________________________________________________

Consumer Number __________________

Consumer EǦmail: ________________________________________________________

Consumer Signature: _____________________________________________________

Date: _________________

Surrogate Name: __________________________________________________________

Surrogate EǦmail: _________________________________________________________

Surrogate Signature: ______________________________________________________

Date: _________________

PCA Name: _________________________________________________________________

PCA EǦmail: _______________________________________________________________

PCA Signature: ____________________________________________________________

Date: _________________

Acuerdo de uso de Hojas de Tiempo Electrónicas

ENVIE POR FAX AL 978Ǧ750Ǧ3639 O

POR CORREO: Northeast Arc FI, 6 Southside Rd,

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Ž •‹•–‡ †‡ Š‘Œ • ‡Ž‡…–”󐋅 • ‡• —

Danvers, MA 01923

•‹•–‡

“—‡ •‡

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–” ˜é• †‡Ž –‡”‡– ‡ ‡Ž …— Ž

I.

‘•—‹†‘”‡•ǡ —•–‹–—–‘•ǡ •‹•–‡–‡• †‡ …—‹† †‘ ’‡”•‘ Ž › ‡Ž ‡”•‘ Ž †‡Ž –‡”‡†‹ ”‹‘

Acerca del sistema de Hojas de Tiempo Electrónicas

ˆ‹•… Ž ’‘†”ᐠ˜‡” Ž

‹ˆ‘” …‹ó ”‡Ž‡˜ –‡

Ž ‹ˆ‘” …‹ó †‡ •—• Š‘Œ • †‡ –‹‡’‘Ǥ

†‹…‹‘ Ž‡–‡ǡ ‡Ž …‘•—‹†‘” › •— •—•–‹–—–‘ǡ ’‡”‘ ‘ ‡Ž •‹•–‡–‡ †‡ …—‹† †‘ ’‡”•‘ ǡ

ˆǤ

’‘†”ᐠ˜‡” ‡Ž „ Ž …‡ †‡ •—

’”‘„ …‹ó †‡Ž •‡”˜‹…‹‘ › •— —–‹Ž‹œ …‹óǤ

‘•—‹†‘”‡•ǡ —•–‹–—–‘• › Ž‘• •‹•–‡–‡• †‡ —‹† †‘ ‡”•‘

’‘†”ᐠ—• ” ‡•–‡ •‹•–‡ ’ ”

•‘‡–‡” › ’”‘„ ” Š‘Œ • †‡ –‹‡’‘ …‘ Ž • Š‘”

“—‡ ‡Ž –” „ Œ ’ ” “—‡ •‡  ’ ‰ † •

‰Ǥ

’‘” ‡Ž –‡”‡†‹

”‹‘ ‹•… ŽǤ

— •—•–‹–—–‘ ’ ” ’‘†‡” —• ” ‡•–‡ —‡˜‘ •‹•–‡ Ǥ

‘ ‡• ”‡“—‡”‹†‘ “—‡ ‡Ž ‘•—‹†‘” –‡‰

‡”‘ ‡ … •‘• †‘†‡ ‡Ž ‘•—‹†‘” –‡‰

— •—•–‹–—–‘ › ‡Ž …‘•—‹†‘” ’”—‡„‡ Ž •—•–‹–—–‘

’ ” “—‡ –‡‰

……‡•‘

‡˜‹ ” Ž • Š‘Œ • †‡ –‹‡’‘ ‡Ž‡…–”󐋅 •ǡ „‘• †‡„‡ –‡‡”

Š „‹Ž‹† †‡• ‹†é–‹… • ’ ” ‡–” ” ›

’”‘„ ” ‡•– • Š‘Œ • †‡ –‹‡’‘ ’ ” •— ’ ‰‘Ǥ ‹ ‡Ž

…‘•—‹†‘” ‘ •‡ •‹‡–‡ …󏑆‘ …‘ ‡•–‡ —‡˜‘ •‹•–‡ ǡ ‡Ž •—•–‹–—–‘ †‡„‡ –‡‡” Ž

Š „‹Ž‹† †

Términos›yŽCondiciones:”‡•’‘• „‹Ž‹† † †‡  ‡Œ ” ‡•–‡ —‡˜‘ ’”‘…‡•‘ †‡ •‘‡–‡” › ’”‘„ ” Ž • Š‘Œ • †‡

II.

–‹‡’‘ ‡Ž‡…–”󐋅

acuerda•Ǥ

†‹”‡……‹ó

Al firmar debajo, usted

seguir los siguientes términos y condiciones:

ŠǤ

Ž …‘•—‹†‘” ›Ȁ‘ •— •—•–‹–—–‘ › ‡Ž •‹•–‡–‡ †‡ —‹† †‘ ‡”•‘ Ž †‡„‡ –‡‡” —

‹Ǥ

†‡ …‘””‡‘ ‡Ž‡…–”󐋅‘ ˜ Ž‹†

Ž

…— Ž

……‡•  †‡  ‡” ˆ”‡…—‡–‡Ǥ

…—‡”†‘

Ž …‘•—‹†‘”ǡ •— —•–‹–—–‘ ȋ•‹

’Ž‹…

Ȍ › ‡Ž •‹•–‡–‡ †‡ —‹† †‘ ‡”•‘ Ž ‡•–ᐠ†‡

‡ —• ” ‡Ž ‹•–‡

‡Ž‡…–”󐋅‘ †‡ ‘Œ

• †‡ –‹‡’‘ …‘‘ é–‘†‘ ’ ” •‘‡–‡” Ž • Š‘” • †‡

–” „ Œ‘ †‡Ž Ǥ

…—‡”†‘ ‘ ”‡“—‹‡”‡ “—‡ •‘Ž‘ ’—‡† —–‹Ž‹œ ” ‡•–‡ ‡†‹‘ ’ ”

•‘‡–‡”

‹Ǥ

Ž ˆ‹” ” ‡•–‡

Ž • Š‘” • –” „ Œ † • ’‘” •— Ǥ –”‘• é–‘†‘• …‘‘ ˆ š‡ ” ‘ ‡˜‹ ” ’‘” …‘””‡‘ Ž

ŒǤ

 Š‘Œ

Š‘Œ †‡ –‹‡’‘ †‡ ’ ’‡Žǡ ‡•

— …‡’– „Ž‡Ǥ

†‡ –‹‡’‘ ‘ •‡”á •‘‡–‹†

‡Ž‡…–”󐋅 ‡–‡ •‹ ‡Ž …‘•—‹†‘” ‘ •— •‹•–‡–‡ †‡

…—‹† †‘ ’‡”•‘ Ž ‘ Š  ˆ‹” †‘ ›

…‘”† †‘ ‡Ž —•‘ †‡ ‘Œ • †‡ –‹‡’‘ ‡Ž‡…–”󐋅 • –” ˜é•

†‡ ‡•–‡

…—‡”†‘Ǥ

•— •—•–‹–—–‘

—• ” ‡Ž •‹•–‡ ǡ ‡–‘…‡• ‡Ž •—•–‹–—–‘ †‡„‡

‹Ǥ

‹ ‡Ž …‘•—‹†‘” ’”—‡„

Ǥ

– „‹é ˆ‹” ” ‡•–‡

…—‡”†‘Ǥ

… † ”‡Ž …‹ó †‡

‡ ‡• ”‡“—‡”‹†‘ — …—‡”†‘ †‡ —•‘ †‡ Š‘Œ • ‡Ž‡…–”󐋅 • ’ ”

‘•—‹†‘”Ȁ “—‡ †‡•‡‡ —–‹Ž‹œ ” ‡•–‡ é–‘†‘ ’ ”

•‘‡–‡” •—• Š‘” • –” „ Œ † •Ǥ •–‘

‡• …‘””‡…–‘ —“—‡ ‡Ž …‘•—‹†‘” ‘ ‡Ž •‹•–‡–‡ †‡ …—‹† †‘ ’‡”•‘ Ž › ‡•–‡ —• †‘ ‡•–‡

•‹•–‡

†‡ Š‘Œ • ‡Ž‡…–”󐋅 • ‡ ‘–”

”‡Ž …‹ó †‡ …‘•—‹†‘”Ȁ•‹•–‡–‡ †‡ …—‹† †‘ ’‡”•‘ ŽǤ

‘„”‡ †‡Ž ‘•—‹†‘”ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴ú‡”‘ †‡Ž ‘•—‹†‘”ǣ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‘””‡‘ Ž‡…–”󐋅‘ †‡Ž ‘•—‹†‘”ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‹”

†‡Ž ‘•—‹†‘”ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‡…Š

ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‘„”‡ †‡Ž —•–‹–—–‘ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‘””‡‘ Ž‡…–”󐋅‘ †‡Ž —•–‹–—–‘ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‹”

†‡Ž —•–‹–—–‘ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‡…Š

ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‘„”‡ †‡Ž ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‘””‡‘ Ž‡…–”󐋅‘ †‡Ž ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‹”

†‡Ž ǣ ̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴

‡…Š ǣ

̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴̴