Sweet Frog Hiring Form PDF Details

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QuestionAnswer
Form NameSweet Frog Hiring Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessweet frog employment application, sweet frog applications, sweetfrog careers, sweet application

Form Preview Example

 

OMB Control No. 2900-0101

 

Respondent Burden: 30 minutes

 

Expiration Date: 06/30/2021

FIRST NAME - MIDDLE NAME - LAST NAME OF VETERAN

 

 

 

 

 

 

 

FIRST NAME - MIDDLE NAME - LAST NAME OF SURVIVING SPOUSE

IMPROVED PENSION ELIGIBILITY

 

VERIFICATION REPORT

 

(SURVIVING SPOUSE WITH NO CHILDREN) 8

 

 

 

COMPLETE MAILING ADDRESS OF SURVIVING SPOUSE

VA FILE NUMBER

 

 

 

 

VA REGIONAL OFFICE RETURN ADDRESS

 

 

 

 

IMPORTANT - Please read the enclosed EVR Instructions (VA Form 21P-0510) prior to completing this form.

1A. YOUR SOCIAL SECURITY NUMBER

1B. VETERAN'S SOCIAL SECURITY NUMBER

1C. YOUR DATE OF BIRTH (Mo., day, yr.)

2.YOUR MARITAL STATUS (Check only one box)

(1) I HAVE NOT REMARRIED SINCE THE VETERAN DIED (You have not married anyone since the veteran's death.)

(2)

 

I REMARRIED ON

 

(Date) AND I AM STILL MARRIED (You married after the veteran's death and you are currently

 

 

 

 

 

 

 

married. Enter the date you married your current spouse.)

(3)

 

I REMARRIED AFTER THE VETERAN DIED BUT THE MARRIAGE ENDED BY DEATH OR DIVORCE ON

.

 

 

(You remarried but you are not currently married. Show the date your latest marriage ended.)

 

 

 

 

 

 

3. NUMBER OF UNMARRIED, DEPENDENT CHILDREN (See Paragraph 1 of the EVR Instructions)

IN YOUR CUSTODY

 

NOT IN YOUR CUSTODY

 

 

 

 

 

 

 

 

 

 

 

 

 

AMOUNT CONTRIBUTED DURING PAST 12 MONTHS TO CHILDREN NOT IN YOUR CUSTODY $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4A. ARE YOU A PATIENT IN A NURSING HOME?

4C. ENTER THE NAME, COMPLETE ADDRESS, AND

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER OF NURSING HOME

 

 

YES

 

NO (If "Yes", Complete Items 4B thru 4D. If "No", go to Item 5.)

(Please include Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4B. SHOW THE DATE YOU ENTERED THE NURSING HOME

 

 

 

4D. DOES MEDICAID COVER ALL OR PART OF YOUR NURSING HOME FEES?

YES NO

5.DID YOU RECEIVE ANY WAGES OR WERE YOU EMPLOYED AT ANY TIME DURING THE PAST 12 MONTHS?

 

 

YES

 

NO

 

 

 

 

 

6. DO YOU RECEIVE ANY OTHER VA BENEFITS AS A VETERAN, PARENT, OR SURVIVING SPOUSE?

 

 

YES

 

 

NO

(If "Yes", write in the VA file number of the other benefit.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VA FORM

21P-0518-1

SUPERSEDES VA FORM 21-0518-1, APR 2015,

PAGE 1

JUN 2018

WHICH WILL NOT BE USED.

 

7A. MONTHLY INCOME (Read Paragraphs 2 and 3 of the EVR Instructions)

If no income or net worth was received from a particular source, write "0" or "none". VA WILL INTERPRET A BLANK SPACE AS "NONE" OR "0."

SOURCE

SURVIVING SPOUSE

SOCIAL SECURITY

$

 

 

 

U.S. CIVIL SERVICE

 

 

 

U.S. RAILROAD RETIREMENT

 

 

 

MILITARY RETIREMENT

 

 

 

OTHER (Show Source)

 

 

 

OTHER (Show Source)

 

 

 

7B. ANNUAL INCOME (Read Paragraphs 2 and 4 of the EVR Instructions)

If no income was received from a particular source, write "0" or "none". VA WILL INTERPRET A BLANK SPACE AS "NONE" OR "0."

NOTE: Report annual income for the dates indicated. If no dates are shown above the columns that follow, then report last calendar year (January through December) income in the left-hand column and current calendar year income in the right-hand column.

SOURCE

FROM:

FROM:

 

 

 

THRU:

THRU:

 

 

 

GROSS WAGES FROM

$

$

ALL EMPLOYMENT

TOTAL INTEREST AND

 

 

DIVIDENDS

 

 

 

 

 

ALL OTHER

 

 

(Show Source)

 

 

 

 

 

ALL OTHER

 

 

(Show Source)

 

 

 

 

 

7C. DID ANY INCOME CHANGE (Increase/Decrease) DURING PAST 12 MONTHS? (Answer "NO" if there were no income changes or if the only change was a Social Security/VA cost-of-living adjustment. Answer "YES" if there were any other income changes or if you received any NEW source of income or any ONE-TIME income)

 

YES

 

NO

(If "YES", complete Items 7D through 7F. If "NO", go to Item 7G.)

7D. WHAT INCOME CHANGED? (Show what income changed, for example, wages, city pension, etc.)

7E. WHEN DID THE INCOME CHANGE?

(Show the dates you received any new income or the date income changed)

7F. HOW DID INCOME CHANGE? (Explain what happened; for example, quit work, got raise, received inheritance)

 

7G. NET WORTH (Read Paragraph 5 of the EVR Instructions)

 

 

 

SOURCE

 

SURVIVING SPOUSE

 

 

CASH/NON- INTEREST-BEARING BANK ACCOUNTS

$

 

 

 

 

 

INTEREST-BEARING BANK ACCOUNTS

 

 

 

 

 

IRA'S, KEOGH PLANS, ETC.

 

 

 

 

 

STOCKS, BONDS, MUTUAL FUNDS, ETC.

 

 

 

 

 

REAL PROPERTY (Not your home)

 

 

 

 

 

ALL OTHER PROPERTY

 

 

 

 

 

8.FAMILY MEDICAL EXPENSES (Read Paragraph 6 of the EVR Instructions)

Normally, medical expenses are reported at the end of the year. If you are using this form as your annual Eligibility Verification Report and Paragraph 6 of the EVR Instructions indicates that you should report medical expenses, use VA Form 21P-8416, Medical Expense Report, to report your medical expenses. If you are using this form as a supplement to a pending claim, you do not need to report medical expenses. If entitlement is established, you will have an opportunity to report your medical expenses at the end of the year.

9.SURVIVING SPOUSE'S EDUCATIONAL AND VOCATIONAL REHABILITATION EXPENSES (Read Paragraph 7 of the EVR Instructions). Show amounts paid by you during the past 12 months. DO NOT REPORT CHILDREN'S EXPENSES.

$

10A. SIGNATURE OF PAYEE (Read paragraph 9 of the EVR Instructions before signing)

10B. DATE SIGNED

10C. TELEPHONE NUMBERS (Include Area Code)

DAYTIME

EVENING

 

 

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, knowing it is false, or fraudulent acceptance of any payment to which you are not entitled.

VA FORM 21P-0518-1, JUN 2018

PAGE 2

How to Edit Sweet Frog Hiring Form Online for Free

The sweet frog job applications completing course of action is easy. Our editor lets you work with any PDF document.

Step 1: To begin the process, select the orange button "Get Form Now".

Step 2: At the moment, you can start modifying your sweet frog job applications. The multifunctional toolbar is at your disposal - insert, erase, transform, highlight, and perform several other commands with the words and phrases in the document.

The next sections are contained in the PDF document you'll be completing.

part 1 to completing sweet frog application form

Provide the appropriate data in the C YOUR DATE OF BIRTH Mo day yr, YOUR MARITAL STATUS Check only, I HAVE NOT REMARRIED SINCE THE, I REMARRIED ON, Date AND I AM STILL MARRIED You, married Enter the date you married, I REMARRIED AFTER THE VETERAN DIED, You remarried but you are not, NUMBER OF UNMARRIED DEPENDENT, IN YOUR CUSTODY, NOT IN YOUR CUSTODY, AMOUNT CONTRIBUTED DURING PAST, A ARE YOU A PATIENT IN A NURSING, YES, and If Yes Complete Items B thru D If area.

Filling in sweet frog application form step 2

The application will request you to write some significant details to automatically fill in the segment B SHOW THE DATE YOU ENTERED THE, D DOES MEDICAID COVER ALL OR PART, YES, DID YOU RECEIVE ANY WAGES OR WERE, YES, DO YOU RECEIVE ANY OTHER VA, YES, If Yes write in the VA file number, VA FORM JUN, SUPERSEDES VA FORM APR WHICH, and Page.

step 3 to entering details in sweet frog application form

Inside the part If no income or net worth was, SURVIVING SPOUSE, SOURCE, SOCIAL SECURITY, US CIVIL SERVICE, US RAILROAD RETIREMENT, MILITARY RETIREMENT, OTHER Show Source, OTHER Show Source, B ANNUAL INCOME Read Paragraphs, If no income was received from a, FROM, THRU, FROM, and THRU, include the rights and responsibilities of the sides.

step 4 to completing sweet frog application form

Review the sections C DID ANY INCOME CHANGE, YES, If YES complete Items D through F, D WHAT INCOME CHANGED Show what, E WHEN DID THE INCOME CHANGE Show, F HOW DID INCOME CHANGE Explain, G NET WORTH Read Paragraph of the, SOURCE, SURVIVING SPOUSE, CASHNON INTERESTBEARING BANK, INTERESTBEARING BANK ACCOUNTS, IRAS KEOGH PLANS ETC, STOCKS BONDS MUTUAL FUNDS ETC, REAL PROPERTY Not your home, and ALL OTHER PROPERTY and thereafter complete them.

Filling in sweet frog application form part 5

Step 3: At the time you click the Done button, your final file is easily exportable to every of your devices. Or, you will be able to deliver it through mail.

Step 4: Produce around a couple of copies of the document to avoid any sort of future challenges.

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