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       Before proceeding, please read the helpful instructions below on how to fill out the following forms:
AVAILABILITY FORM
     
Applicant’s Printed Name: *
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What is your primary language? *  
Which other languages do you speak?  
Do you have your own car? *  
Will you work in a home with a smoking patient? *  
Will you work in a home with Pets? *  
Do you have knowledge of a kosher kitchen?*  
     
Please fill in the chart below with the time you are available for each day. If you are not available, leave the box blank for that day.
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End Time: (AM/PM) AM
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I am willing to work Live In or Overnight cases






* Live in is defined as 24 hour shifts (13 hours paid) where you will live .You will live in the patient’s home up to a week, typically 3-4 days
* Overnight cases are defined as 12 hour shifts (PM to AM)
     

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JOB DESCRIPTION

Personal Care Aide / Home Health Aide
Report to: The Nurse Supervisor

The aide will follow the plan of care written by the nurse that will encompass all or part of the duties as listed.

QUALIFICATIONS

PCA: Formal schooling is flexible as long as the aide has the ability to understand and complete the forms necessary to maintain records that the Personal Care Aide, (PCA), is required to complete. The requirements are completion of a PCA training course approved by the New York State DSS or documentation of at least six (6) months of experience caring for clients within the past year and satisfactory completion of an exemption exam including skills assessments. HHA: Formal schooling is flexible as long as the aide has the ability to understand and complete the forms necessary to maintain records that the Home Health Aide, (HHA), is required to complete. The requirements are satisfactory completion of a 75-hour HHA training course approved by the New York State Department of Health and experience in daily living with compassion and maturity necessary to understand and react with people. High school diploma preferred.

MAIN FUNCTION:

To maintain clients in their own home by primarily providing limited hands on care with light housekeeping and meal preparation as a secondary function within the confines of the client's immediate surroundings.

  • Duties and Responsibilities:

    • Assist with the care of teeth and mouth.
    • Assist with grooming – care of hair including shampoo, shaving with an electric shaver only, ordinary care of nails finger and toes (filing only, no cutting).
    • Assist with bathing of client in bed or in the shower with a tub bench.
    • Assist client with transfers to and from bedpan, commode and toilet.
    • Assist client in moving from bed to chair, wheelchair and in walking.
    • Assist client with eating.
    • Assist client with dressing.
    • Accompany client to obtain medical care.
    • Assist client with the use of devices geared to disability as aids to daily living, such as walker, cane, braces, etc.
    • Assist the client with preventative skin care.
    • Assist self-directing client with oral medications ordinarily self-administered by the client.
    • Keep simple records as instructed by the nurse/case manager.
    • Prepare and serve meals according to instructions.
    • Make and change beds.
    • Dust and vacuum the rooms the client uses.
    • Light housekeeping.
    • Wash and dry dishes.
    • Tidy kitchen, bedroom, and bathroom.
    • List needed supplies i.e. Milk, garbage bags, laundry detergent, etc. as the products are used up.
    • Weekly grocery shopping for supplies needed by the client.
    • Shop for client as needed.
    • Do client's laundry as needed. This may include necessary mending and ironing. Remember to separate laundry and watch water temperature as to not ruin their clothing. Hang up necessary item as directed.
    • Remind client to take medication.
    • Follow HIPAA and HIV privacy policy.

    HHA's Only:

    If no family member is present or capable of providing for a specific client, the supervising nurse may, with approval of the physician, teach and closely supervise the HHA in the following procedures:

    • Check temperature, pulse and respiration and record when/as necessary according to nurse's request.
    • Remind client, as directed by the Physical Therapist, about daily/weekly exercises.
    • Empty Foley Catheter Bag.
    • Simple dressing as directed by the nurse.
    • Measure I & O as ordered.
    • Other permissible HHA Duties as requested and identified by nurse on the plan of care.

    Do Not Do the Following:

    • Work independently for any of the agency's clients.
    • Accept gifts or money from any client or family member of the client.
    • Discuss salary or transportation expenses with the client.
    • Make any scheduling changes with the client directly; all changes must be done through the office first.
    • Return to the client after a vacation without contacting the office first.

ONLY PERFORM DUTIES WHICH ARE LISTED IN THE PLAN OF CARE

Call the Coordinator if there is a duty the patient is requesting, and it is not on plan of care.

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For Support call: 845-203-1602. Available Mon- Thurs 9am-5pm and Fri 9am-1pm

Notice and Acknowledgement of Pay Rate and Payday
Under Section 195.1 of the New York State Labor Law
for Home Care Aides Wage Party and Other Jobs
     
1. Employer Information:
Name :

Community Health Aide Services
Doing Business As (DBA) Name(s) :

Community Home Health Care
FEIN (optional): 14-1694451
Physical Address :

49 North Airmont Rd,
Montebello NY 10901
Mailing Address :

49 North Airmont Rd,
Montebello NY 10901
Phone :

845-425-6555
2. Notice given:

Note: Live-in employees must be paid at least 13 hours for each 24 hour period, provided they receive 8 hours of sleep, with five hours of uninterrupted sleep and 3 hours off for meals. If an employee does not receive 5 hours of uninterrupted sleep, the employee must be paid for all 8 hours. If the employee does not receive meal periods free from duty, the employee must be paid for all 3 hours designated for meals.
3. Employee’s Rate(s) of Pay for Each Type of Work Shift:
See attached list of rates $per hour for $per hour for $per hour for
3a. Wage Parity Rates:
See attached list of rates $per hour for regular wage $per hour for additional wage $per hour for supplemental wages*
4. Allowances:

5. Regular payday:
6. Pay is:

7. Overtime Pay Rate(s) foreach type of work or shift:
See attached list of rates
Single Pay Rate: $ per hour This must be at least 1½ times the worker's regular rate with few exceptions.
See attached list of rates
Wage Parity Pay Rate: $ per hour This must be at least 1½ times the worker's regular rate with few exceptions.
See attached list of rates
Multiple Pay Rates: $ per hour This must be at least 1½ times the worker's Weighted average of the multiple rates of pay for the week, with few exceptions.
8. Employee Acknowledgement:

On this day I have been notified of my pay rate, overtime rate (if eligible), allowances, supplements and designated payday. I told my employer what my primary language is.

Check one:

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The employee must receive a signed copy of this form. The employer must keep the original for 6 years.

Please note: It is unlawful for an employee with protected class status to be paid less than an employee without protected class status, if they are performing substantially equal work. Employers also may not prohibit employees from discussing wages with their co-workers.

*Attach Wage Parity supplement notification

LS 62 Notice to Wage Parity Home Care Aides - (cont'd)
Benefit Portion of Minimum Rate of Home Care Aide Total Compensation
     
  Hourly Rate Type of Supplement Name & Address of Provider Agreement/Plan information
Supplement Number $XXX (Pension, Welfare, or Other) Insert Name and Address of Company or Organization Providing Benefit Identify the plan or agreement that creates the benefit, e.g Union Local No. 1 Collective Bargaining Agreement or Insurance Company X benefit Plan
Supplement Number1 See attached list of rates Transit, parking, cell phone,FSA, dependent care Leading Edge 14 WALL ST. STE 5B, NEW YORK, NY 10005 Leading Edge
Supplement Number2   PTO   As per Community's Employee Handbook Policy
Supplement Number3   Sick   As per Community's Employee Handbook Policy

*If wage supplements are paid as a single payment owed to multiple Taft-Hartley multiemployer plans, list only the following: (1) the total paid for the supplement or benefit package; (2) the types of benefits included in the package, e.g., pension, health and welfare, or other; (3) the name and address of the entity to whom payment is sent; and (4) the relevant CBA or letter of assent as the agreement.

List any additional benefits and attach listing to this document.

Copies of the above listed agreements or summaries may be obtained by:

Human Resources     at 845-425-6555
Employee Acknowledgement:

On this day I have been notified of my pay rate, overtime rate, allowances, supplements/benefits,
and designated payday provided on this form (LS 62) attached and this addendum on the date given below.
My primary language is *. | have been given this notice in my primary language *   Yes    No.
Employee Name (Print): *
Employee Signature: *

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Step 1: Enter Personal Information
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(c)
     
     

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, other details, and privacy.
Step 2: Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Reserved for future use.

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or

(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate . . . . . ?

TIP: If you have self-employment income, see page 2.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
Step 3: Claim Dependent and Other Credits

If your income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of qualifying children under age 17 by $2,000 ? $

Multiply the number of other dependents by $500.......? $

Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here $

3 $
Step 4 (optional): Other Adjustments

(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income

 4(a) $

(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here

 4(b) $

(c) Extra withholding. Enter any additional tax you want withheld each pay period

 4(c) $
Step 5: Sign Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

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Employers Only
For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2023)
Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job. To be accurate, submit a new Form W-4 for all other jobs if you have not updated your withholding since 2019.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional tables.
1 Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the “Lower Paying Job” column, find the value at the intersection of the two household salaries and enter that value on line 1. Then, skip to line 3... 1 $
2 Three jobs. . If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.

a Find the amount from the appropriate table on page 4 using the annual wages from the highest paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries and enter that value on line 2a...

b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount on line 2b...

c Add the amounts from lines 2a and 2b and enter the result on line 2c...

2a

2b

2c

$

$

$

3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc... 3 $
4 Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional amount you want withheld) 4 $
Step 4(b)—Deductions Worksheet (Keep for your records.)
1 Enter an estimate of your 2023 itemized deductions (from Schedule A (Form 1040)). Such deductions may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 7.5% of your income ... 1 $
2

Enter:
- $27,700 if you’re married filing jointly or qualifying surviving spouse
- $20,800 if you’re head of household
- $13,850 if you’re single or married filing separately }

 2 $
3 If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater than line 1, enter "-0-"... 3 $
4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information... 4 $
5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4... 5 $

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person with no other entries on the form; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and territories for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.
For Support call: 845-203-1602. Available Mon- Thurs 9am-5pm and Fri 9am-1pm
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*

Note: If married but legally separated, mark an X in the Single or Head of household box.
Are you a resident of New York City? *
Are you a resident of Yonkers? *
Before making any entries, see the Note below, and if applicable, complete the worksheet in the instructions.

1 Total number of allowances you are claiming for New York State and Yonkers, if applicable ((from line 19, if using worksheet)...

2 Total number of allowances for New York City (from line 31, if using worksheet)...

Use lines 3, 4, and 5 below to have additional withholding per pay period under special agreement with your employer.

3 New York State amount... $

4 New York City amount... $

5 Yonkers amount... $

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

Penalty – A penalty of $500 may be imposed for any false statement you make that decreases the amount of money you have withheld from your wages. You may also be subject to criminal penalties.

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Employee: Give this form to your employer and keep a copy for your records. Remember to review this form once a year and update it if needed.

Note: Single taxpayers with one job and zero dependents, enter 1 on lines 1 and 2 (if applicable). Married taxpayers with or without dependents, heads of household or taxpayers that expect to itemize deductions or claim tax credits, or both, complete the worksheet in the instructions. Visit www.tax.ny.gov (search: IT-2104-I) or scan the QR code below.

Employer: Keep this certificate with your records.
If any of the following apply, mark an X in each corresponding box, complete the additional information requested, and send an additional copy of this form to New York State. See Employer in the instructions. Visit www.tax.nys.gov (search: IT-2104-I) or scan the QR code below.

A Employee claimed more than 14 exemption allowances for New York State...A

B Employee is a new hire or a rehire...B    First date employee performed services for pay (mm-dd-yyyy) (see Box B instructions.):

You may report new hire information online instead of mailing the form to New York State. Visit www.nynewhire.com.

Note: Employers must report individuals under an independent contractor arrangement with contracts in excess of $2,500 using the online reporting website above, not Form IT-2104.

Are dependent health insurance benefits available for this employee?...

If Yes, enter the date the employee qualifies (mm-dd-yyyy):


 
 

Scan here

https://www.tax.ny.gov/r/it2104i-2023
For Support call: 845-203-1602. Available Mon- Thurs 9am-5pm and Fri 9am-1pm

ACKNOWLEDGMENT OF RECEIPT

I hereby acknowledge receiving a copy of the Agency’s Handbook. I have had the opportunity to ask questions about the policies. As a condition of my employment with the Agency, I agree to comply with all the rules and procedures of the Agency, as stated in this Handbook and any other document that may be issued to me during my employment, including the FAIR AGREEMENT.

I understand that the Agency has the maximum discretion permitted by law to interpret, administer, add to, change, or delete provisions in this Manual and Handbook at any time.

Additionally, I acknowledge that no promise of job security has heretofore been given to me and that there are no such promises contained in the Handbook since I am employed AT WILL and may resign at any time or be fired from my job at any time, with or without notice and with or without cause.

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Download benefits Pamphlet here Download handbook here
For Support call: 845-203-1602. Available Mon- Thurs 9am-5pm and Fri 9am-1pm