[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-160051-en":3,"doc-seo-160051-105":31,"detail-sidebar-cat-0-en-105":92},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":22,"language":23,"language_code":24,"site_id":25,"html_lang":24,"table_of_contents":26,"faqs":27,"seo_title":28,"seo_description":14,"update_tm":29,"read_time":30},160051,13056712833777,"Paura","https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0",4,"Exam","PCA Application Checklist - Signature Forms - 2/11/25","Employment application and required signature forms for hiring a Personal Care Attendant (PCA) through Summit Independent Living. Includes a document checklist confirming completed paperwork (PCA application, W-4 federal, MW-4 Montana, background check authorization, I-9 eligibility verification, identification copies, optional direct deposit), submission instructions, and date/location contact details. Contains application questions covering ADA accommodations, eligibility, experience, lifting ability, exclusion database status, and a detailed criminal background check authorization describing scope, confidentiality, and disqualification conditions. Also includes the Montana Employee’s Withholding and Exemption Certificate fields and filing status guidance.","issuance of a paycheck.  \n□ PCA Application  \n□ Form W4(Federal)  \n□ Form MW4(Montana)  \n□ Summit Drug-Free WorkPlace Statement  \n□ Summit Safety Policy Statement  \n□ Summit Personal AssistantManual Sign-off  \n□ PCA Job Description  \n□ Safety Policy &Procedure Manual  \n□ Payroll Calendar  \n#                           Signature\n\nPCA Application Checklist  \nThis checklist is for vour assurance that all the required paperwork iscompleted and returned to us for processing.Not submitting all requireddocumentation will result in a delay in caregivers receiving their pay.Pleasecheck the boxes as you complete each item and sign below that you havereviewed and submitted all required documentation.  \n## 1.Each form below is necessary in the caregiver employment and\n\n□ Criminal Background CheckAuthorization Form  \n□ I-9 Employment EligibilityVerification (Signed midway)  \n□ Copies of 2 Forms of Identification(usually driver's license and social security card)  \n□ Direct Deposit Authorization optional  \n## 2.Forms the caregiver should have received for their keeping:\n\n□ Personal Assistant Manual  \n□ Change of Address Form  \n## 3.Send the completed forms from the first section to:\n\nSummit Independent Living3104 West BroadwayMissoula,MT 59808  \nThe completion of the employment papers and the receipt of the job descriptionand manuals completes the work agreement with Summit.  \nIf you have any questions,please feel free to call us at 406-728-1630.  \n            Date      \n2/11/25  \n# Application for Employment\n\nConsistentwith the provisions ofthe Americans with DisabilitiesAct(ADA),applicants mayrequestaccommodations needed to participate in the application process.  \nName:_                                                                          LastFirstMiddleMaidenMailing AddressStreet Address (if differentfrom mailing)CityStateZipCityStateZipPhoneE-mail Address (required)  \nDo you have avalid driver's license?□YES □NO  \nHave you ever been convicted of a crime?□YES □NOIf yes,please explain:                           \nAre you listed in the Exclusions Database of the Office of Inspector General through the USDepartmentof Public Health and Human Services Fraud Prevention Program?  \n□YES    □NO  \nDo you have experience working as a personal care attendant?□YES □NO  \nThis job may require lifting.Are you able to perform this function?□YES □NO  \nHave you reviewed the Personal Care Attendant Manual that you received with thisapplication packet?□YES     □NO  \n□YES □NO  \nHave you included copies of your identification?(Please see attached list of acceptable documents)  \nSummit Independent Living3104W.Broadway,Missoula,MT 59808Phone:(406)728-1630·Fax:(406)829-3309  \n# Criminal Background Check Authorization Form\n\nName:                                                                                    \n(Last)(First)(Middle)Other Names Used:                                       Current Address:                                       City,State,ZIP:                                  Social Security Number:                _Date of Birth:          Telephone:                      \nIn connection with my employment in the Self-Directed CFC/PAS program through Summit IndependentLiving,I hereby authorize Summit Independent Living to conduct a criminal background check on mybehalf.I understand that this check will cover a national search of law enforcement and court records,acheck of the NationalSex Offender Public Registry,and the Exclusion List of the federal Office of InspectorGeneral.I understand that my ability to serve as an employee with Summit Independent Living iscontingent upon the results of the background check.I understand that failure on my part to consent tothe criminal background check will result in the revocation of any position offered to me or accepted byme.I further understand that the criminal background check information will be kept confidential andthat Iam entitled to receive and review the information obtained,upon request.  \nThere is a","cbCaim6Ufz8cXjjN","https://ap.wps.com/l/cbCaim6Ufz8cXjjN","pdf",2792332,7,1,22,"English","en",105,"# PCA Application Checklist\n## Required Forms and Submission Instructions\n## Application for Employment\n# Criminal Background Check Authorization Form\n# Montana Employee's Withholding and Exemption Certificate","[{\"question\":\"What documents must be completed and returned before processing PCA employment paperwork?\",\"answer\":\"The checklist requires PCA Application, Form W-4 (Federal), Form MW-4 (Montana), Summit Drug-Free Workplace Statement, Summit Safety Policy Statement, PCA Personal Assistant Manual sign-off, PCA job description/manuals, plus Criminal Background Check Authorization, I-9 eligibility verification, and copies of two forms of identification. Optional direct deposit authorization may also be included.\"},{\"question\":\"What happens after submitting the criminal background check authorization?\",\"answer\":\"Summit Independent Living conducts a national search of law enforcement and court records, checks the National Sex Offender Public Registry, and reviews the federal Exclusion List. Employment eligibility depends on the results, and refusal to consent revokes any offered or accepted position. Information is kept confidential and can be reviewed upon request.\"},{\"question\":\"What is the purpose of the Montana Employee’s Withholding and Exemption Certificate (MW-4)?\",\"answer\":\"The MW-4 form helps the employer withhold the correct Montana income tax from pay. It requires federal filing status selections and includes options for extra or specified withholding amounts.\"}]","PCA Application Checklist - Signature Forms - 2/11/25 | PDF",1788049506,55,{"code":4,"msg":32,"data":33},"ok",{"site_id":25,"language":24,"slug":34,"title":13,"keywords":35,"description":14,"schema_data":36,"social_meta":87,"head_meta":89,"extra_data":91,"updated_unix":29},"pca-application-checklist-signature-forms-21125","",{"@graph":37,"@context":86},[38,54,69],{"@type":39,"itemListElement":40},"BreadcrumbList",[41,45,49,52],{"item":42,"name":43,"@type":44,"position":21},"https://docshare.wps.com","Home","ListItem",{"item":46,"name":47,"@type":44,"position":48},"https://docshare.wps.com/document/","Document",2,{"item":50,"name":12,"@type":44,"position":51},"https://docshare.wps.com/document/exam/",3,{"item":53,"name":13,"@type":44,"position":11},"https://docshare.wps.com/document/pca-application-checklist-signature-forms-21125/160051/",{"url":53,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":24,"description":14,"dateModified":62,"datePublished":63,"encodingFormat":61,"isAccessibleForFree":64,"interactionStatistic":65},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":42,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-09-11","2026-08-30",true,{"@type":66,"interactionType":67,"userInteractionCount":20},"InteractionCounter",{"@type":68},"ViewAction",{"@type":70,"mainEntity":71},"FAQPage",[72,78,82],{"name":73,"@type":74,"acceptedAnswer":75},"What documents must be completed and returned before processing PCA employment paperwork?","Question",{"text":76,"@type":77},"The checklist requires PCA Application, Form W-4 (Federal), Form MW-4 (Montana), Summit Drug-Free Workplace Statement, Summit Safety Policy Statement, PCA Personal Assistant Manual sign-off, PCA job description/manuals, plus Criminal Background Check Authorization, I-9 eligibility verification, and copies of two forms of identification. 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