Personal Care Attendant Information & Resources

To download the complete PA Packet, click here.

Please follow the setps listed below in order to complete the employment packet that is attached:

1. Cover Letter for PCA to return with the PCA Packet
   1. This link is the cover sheet to place over your information when returning to CILSWKS.
2. Personal Care Attendants Application for Employment
   1. Carefully read the instructions.
   2. Fill out the entire application.
3. Personal Care Attendants Policies and Procedures
   1. Read the entire page.
   2. Under the header of "Confidentiality Policy" sign on line indicated for the Attendant's signature and date.
   3. Under the header of "Employee Information" sign on line indicated for the Attendant's signature only if the attendant gives permission for the information to be given to agencies or businesses regarding their wages and length of employment.
   4. Under the header of "Drug-Free Workplace Policy" sign on line indicated for the Attendant's signature and date and also for the Witness signature.
   5. The last page "Certificate of Acknowledgement" must be signed and dated by the Attendant, Center for Independent Living of Southwest Kansas Personal Care Attendant Manager and the Executive Director.
4. Employee's Withholding Allowance Certificate (Form W-4)
   1. Fill out the form items 1-7. This form must have signature and date.
5. Employment Eligibility Verification (I-9 Form)
   1. Read the information at the top and fill the form out completely including the Attendant's signature and date.
6. Personal Care Attendant's Direct Deposit Form (Yellow Papers)
   1. On the direct deposit form read and fill out all the blanks.
   2. Write void over a deposit slip and attach it to the bottom of the form where it said "Attach Here" before turning it in.
7. Adult KBI Authorization for Release of Information
   1. Read the information at the top and fill the form out completely including the Attendant's signature and date.
8. Child KBI Authorization for Release of Information
   1. Read the information at the top and fill the form out completely including the Attendant's signature and date.
9. Bloodborne Pathogens Information Sheet and Control Plan Sheet
   1. Read the entire three pages.
   2. On page three, sign and date of the Attendant and a Witness.
10. Employment Agreement
    1. This form indicates which tasks the Consumer needs assistance.
    2. Consumer and Personal Attendant must read and sign this form.
11. Form PA-PAR1
    1. This form should be signed by the Consumer indicating how much an hour he/she wants his/her Attendant to get paid. Hourly pay rate requested must not exceed $9.00.
    2. Attendant's name, address, phone number, and Social Security Number shhould be supplied at the top of this form.
12. Termination Forms (Pink Papers)
    1. These forms are to be kept by the Consumer.
    2. If and when a Personal Attendant is terminated or quits, please fill this form out, sign by both Consumer and Attendant and send it back to CILSWKS.
13. HIPAA Statements (PRINT TWO COPIES RETURN ONE COPY)
    1. These forms should both be signed by the Personal Care Attendants. The PCA keeps one copy in her file and returns one copy to CILSWKS

** Note: Consumer Signature must be on PA Packets and PA Timesheets in the specified areas.

Health Insurance Portability and Accountability Act (HIPAA) guidelines are strickly enforced. All information obtained from this resource and employment site are to remain strickly confidential. All violations will be handled to the fullest extent of the law

Copyright © 2006-2008; Center for Independent Living Southwest Kansas. All rights reserved.