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HOME CARE SERVICES FOR
MEDICARE BENEFICIARIES

1 800-HOME-CARE
1 800-768-4663

FAX: 586-585-0209

EMPLOYMENT APPLICATIONS

Downloads

Application

Background Check Application Form

Form I-9

Form W-4

Form MI-W4

Payroll/New Hire/Change of Status

Employee Reference Request


Please send forms to kkleinow@exhhc.com.

The following items need to be COPIED for the employee file.

  • SSN Cards
  • Driver’s License
  • Auto Insurance
  • Professional License (If applicable)
  • Resume
  • CPR Card (If applicable)
  • Diploma/Transcript (If applicable)
  • TB Test/or Chest X-Ray
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