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Background Check Authorization of Release
Direct Deposit Authorization Form
Weekly Service Log-In & Out Sheet
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Home
About Us
Services
Careers
Onboarding
Background Check Authorization of Release
Direct Deposit Authorization Form
Weekly Service Log-In & Out Sheet
Get Started
Weekly Service Log-In & Out Sheet
Client
First
Last
Sunday Date
MM slash DD slash YYYY
Time In
Hours
:
Minutes
AM
PM
AM/PM
Time Out
Hours
:
Minutes
AM
PM
AM/PM
Hours wk.
Monday Date
MM slash DD slash YYYY
Time In
Hours
:
Minutes
AM
PM
AM/PM
Time Out
Hours
:
Minutes
AM
PM
AM/PM
Hours wk.
Tuesday Date
MM slash DD slash YYYY
Time In
Hours
:
Minutes
AM
PM
AM/PM
Time Out
Hours
:
Minutes
AM
PM
AM/PM
Hours wk.
Wednesday Date
MM slash DD slash YYYY
Time In
Hours
:
Minutes
AM
PM
AM/PM
Time Out
Hours
:
Minutes
AM
PM
AM/PM
Hours wk.
Thursday Date
MM slash DD slash YYYY
Time In
Hours
:
Minutes
AM
PM
AM/PM
Time Out
Hours
:
Minutes
AM
PM
AM/PM
Hours wk.
Friday Date
MM slash DD slash YYYY
Time In
Hours
:
Minutes
AM
PM
AM/PM
Time Out
Hours
:
Minutes
AM
PM
AM/PM
Hours wk.
Saturday Date
MM slash DD slash YYYY
Time In
Hours
:
Minutes
AM
PM
AM/PM
Time Out
Hours
:
Minutes
AM
PM
AM/PM
Hours wk.
Services Provided
Bathing
Grooming
Dressing
Toileting
Prep Food Transfers
Ambulation
Laundry
Basic Cleaning
Special Notes
ELECTRONIC SIGNATURE ACKNOWLEDGEMENT AND CONSENT
(Required)
I, Agree to Electronic Signature Consent:
I, agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.
Service Provider Signature
Date
MM slash DD slash YYYY
Client Signature
Date
MM slash DD slash YYYY
