I have received, read and understand my role and responsibilities as Personal Assistant working for a Consumer or their Designated Representative participating in the MEADOWS HOME CARE CDPAP. I have had an opportunity to ask questions concerning my wage and benefit package. I understand that MEADOWS HOME CARE CDPAP is the Fiscal Intermediary and is responsible for processing on behalf of the Consumer the payroll and benefit administration for the PA. I understand that MEADOWS HOME CARE CDPAP is NOT my employer.

I understand that I am hired, trained, supervised and receive my schedule by the Consumer and/or their Designated Respresentative. I also understand it is the Consumer or Designated Representative who can terminate my services or dismiss me from working for them if they choose to do so.

PA Name: (print)

 

Date:

 

HR Representative:
Date: