An Extra Hand Home Care

Download ACH Form provided below. Complete it, sign it, and then upload this completed ACH attachment to this site.

Click to Open: ACH Direct Deposit

Employee ID and Cust ID LEAVE BLANK - Upon completion, upload below.)

Make Sure to complete this form and upload the payroll ACH Form provided above to submit below.

Step 1: Enter Personal Information: *

First

Last

DOB *//

Date of Birth

Adress *

Applicant's current address

City or Town, State, and Zip Code *

City, State, Zip Code

Social security number *

Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

Step 2: What filing status will you use for your tax return?* *

Number of Dependents *

If Dependent is An Adult, Specify with the Number of Dependents listed. If Exempt, Put EXEMPT not 0.

Step 3: What State were you born in? If not born in the USA, what city or province were you born in? *

Answer Question No: 1

Were you born in the U.S.A? If not, what country were you born in? *

Answer Question No: 2

Are you certified in the state of Georgia to work as a caregiver? If so, what certification(s) do you currently have? *

Answer Question No: 3

Are you certified in any other states? If so, please specify the other states you are certified in. *

Answer Question No: 4

Step 4: Date *

Today's Date

Sign Here - Employee’s signature (This form is not valid unless you sign it.) *

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

Step 5: ACH Direct Deposit Form Upload *

Click or drag files to this area to upload. You can upload up to 3 files.

Upload ACH for Payroll Direct Deposit and Scroll down and select Submit

Withholdings

Download ACH Form provided below. Complete it, sign it, and then upload this completed ACH attachment to this site.

Click to Open: ACH Direct Deposit

Employee ID and Cust ID LEAVE BLANK - Upon completion, upload below.)

Employer: An Extra Hand Home Care

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