1-800-473-4427 sfarrar@homecompanion.com

EMPLOYMENT APPLICATION – PART 01

The I-9, W-4, and LS54 forms have to be downloaded, printed, and sent to HCS via EMAIL – jhunt@HomeCompanion.com or fax (631) 473-9507 with a live signature (No electronic signature).

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Application Checklist

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Application for Employment STEP-01

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Employment History STEP-02

Section-2-Employment-History

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to download and print our
Non-Solicitation Agreement STEP-03

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to download and print our
Criminal Background Check Authorization STEP-04

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Disclosure & Authorization for Background Investigation STEP-05

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Health Status – STEP-06

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Personal Health Information Pledge of Confidentiality – STEP-07

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
New York State Correction Law Acknowledgement – STEP-08

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Phone Number Agreement – STEP-09

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Personal Reference – STEP-10

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Employer Reference #1 – STEP-11

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Employer Reference #2 – STEP-12

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to fill out our
Comprehensive Signature Page – STEP-13

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to download and print our
i-9 2023 – 2026 form

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to download and print our
W4 2024 – 2026 form

Please CLICK THIS LINK or CLICK THE IMAGE BELOW to download and print our
NYS Dept of Labor LS54 form

Reach Us

Servicing all of Nassau and Suffolk Counties, Brooklyn, Queens, Manhattan and the Bronx.

Toll Free: 1-800-473-4427
Phone: 631-473-0700
Fax: 631-473-9507

46 NY-25A
#8
East Setauket, NY 11733

Susan Farrar, Administrator
sfarrar@homecompanion.com

Request home care for your loved one here by inquiring online below.

Please Choose One

Let's Stay Connected

Stay up to date with our latest news and information. Fill out the form below