Get Writable Employee Information Form

The Writable Employee Information Form is essential for providing necessary employee details and ensuring compliance with employment regulations. This guide will walk you through the steps required to complete this form accurately online.

Follow the steps to fill out the Writable Employee Information Form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the employer's (participant's) name and the participant’s CDC+ ID number in the designated fields.
3. Complete the required employee information section by entering your name as it appears on your Social Security card, including your last name, first name, phone number, address, city, state, zip code, Social Security number, email address, and date of birth.
4. Designate a contact person if your mail is returned by entering their last name, first name, phone number, and relationship to you.
5. Indicate your relationship to the employer (participant) by checking the appropriate box. Options include parent, child, spouse, under age 18 and still in high school, or none of the above.
6. Provide the required information for program reporting by checking the appropriate box that describes your relationship to the CDC+ participant.
7. Respond to the residence question by checking 'Yes' or 'No' to determine if you are claiming live-in status with the participant.
8. Verify your background screening status by answering the questions related to Medicaid enrollment, professional licensing, unemployment status, and whether a background screening clearance letter has been attached, checking 'Yes' or 'No' as applicable.
9. Sign the form providing your certification that the information is true and correct, followed by the signature of the participant or representative.
10. Once all sections are filled out completely, save your changes, and download, print, or share the form as needed.

Complete and submit your Writable Employee Information Form online today!