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E ONLY PARA EL USO de la OFICINA SOLAMENTE - - - - - - - - - Payment for service dates beyond 45 days can be delayed by two or more paydays. Pagos por fechas de servicio prove dos m s all de 45 d as, ser n retrasados por dos fechas de pago o m s. mailing address P O Box 3380 Paso Robles, CA 93447 phone: 805-227-4147 toll-free phone: 1-855-741-4722 fax: 805-227-6535 toll-free fax: 1-855-535-6722 email: fax respiteinc.com website: www.respiteinc.com office location 419 15th Street.

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Follow the steps to complete the form online:

  1. Press the ‘Get Form’ button to access the Respite Inc. - Forms/Formas and open it in your preferred editor.
  2. Begin by entering your payroll number in the designated field labeled 'payroll #/# de planilla'.
  3. Input the current date in the 'date/fecha' section.
  4. Print the name of the individual providing services in the 'print worker’s name/escriba el nombre del trabajador' field.
  5. Provide a phone number in the 'phone number/número de teléfono' section.
  6. If this is a new worker, indicate this by checking the box labeled 'NEW?NUEVA¿'.
  7. Fill in the 'mailing address/dirección de correo' to specify where correspondence should be sent.
  8. Enter the email address in the 'email address/correo electrónico' field.
  9. Record the service start date in the 'Start/Comienzo' section and the end date in the 'End/Fin' section.
  10. Document the total hours worked in the 'Hours/Horas' field.
  11. If applicable, indicate miles traveled in the 'Miles/Millas' section.
  12. Print the client’s name in the ‘Print Client Name - Cliente/Hijo/a Nombre’ field.
  13. Obtain the necessary signatures: the 'Parent/Guardian Signature' and the 'Worker Signature'.
  14. Finally, confirm your preferences regarding check pickup by checking the appropriate box: 'I will pick up my check'.
  15. Once all fields are completed, you can save changes, download, print, or share the form as needed.

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