EmailMe Form - WTPA - LIVE-IN WAGE AGREEMENT 2017

Today's Date *
MM / DD / YYYY
LIVE IN WAGES - 2017 *
This agreement serves to disclose payment information for live-in shifts effective January 1, 2017
Name *
Your Email (Caregiver) *
Last 4 digits of my SS# *
My Date of birth *
MM / DD / YYYY
Proof of Identity
LIVE-IN SHIFTS - Hourly Wage will be *
$11 per hour (subject to the calculations below)
LIVE-IN SHIFTS - Overtime Wage will be *
$16.50 per hour (for hours over 40)
Live-Ins - Wages and Overtime detailed breakdown

(hypothetical breakdown if I were to work all the days detailed herein) *
(*) I understand Day 1 will earn me $159.50 (14.5 hours of work multiplied by the regular hourly rate)/ cumulative amount for the week of $159.50
(*) I understand Day 2 will earn me $159.50 (29 hours of work multiplied by the regular hourly rate)/ cumulative amount for the week of $319
(*) I understand Day 3 will earn me $178.75 (11 hours of work multiplied by the regular hourly rate plus 3.5 hours of overtime (1.5 x the regular hourly rate))/ cumulative amount for the week of $497.75
(*) I understand Day 4 will earn me $239.25 (14.5 hours of work, all overtime hours computed at 1.5 x the hourly rate)/ cumulative amount for the week of $737
LIVE-IN, for each 24-hour shift on a Sleep-In Case, I agree: *
(a) I will be paid by HISC for 14.5 hours worked at the hourly wage established above for every live-in shift I take.
(b) I will be provided 8 hours of sleep-time and will not be paid for this time. 5 of the 8 hours must be without interruption
(c) I will be entitled to three (3) 30 minute uninterrupted meal breaks according to the HISC Meal Breaks Policy stated in the HISC handbook.
(d) I will record all tasks I performed for the Client on each 24-hour shift using the reporting method required by the Agency.
(e) I will report to the HISC office immediately upon completion of each 24- hour shift, if I was (i) unable to receive 5 hours uninterrupted sleep-time or (ii) interrupted by a call to duty at any time during my total 8 hours sleep-time.
(f) I will report to the HISC office immediately upon completion of each 24-hour shift if I was unable to receive 1.5 hours of uninterrupted break time.
Employer *
I understand Home Instead Senior Care (legal name is Home Care Associates Inc) is located at 400 East 56th St NY NY 10022 and the phone # is 212-614-8057
I further agree that *
All other provisions of my work employment remain in effect as established by the handbook and acknowledgements I signed.
Pay Date *
I understand Paydate is every other Friday for the 14 calendar day period ending the previous Saturday.
Work week (for calculating overtime) *
I understand that the work week starts Sundays at 12:00 a.m. and ends Saturdays at 11:59 p.m.
Review Paystub. *
I will record correctly all work time and review my pay stubs to identify what I believe are any mistakes (i.e. errors in deductions, reported hours of work or any other errors).
I will report to the HISC office in writing, promptly following receipt or the direct deposit of my paycheck for hours worked in any week, if I believe I was paid improperly or not paid for all hours worked.
Signature *
Clear
Sign your name with mouse or with your finger
Any questions? Call us at 212-614-8057 or email us at *