GFR Office-Technician New Hire Check List

1. GFR Employment Agreement
2. Application for Employment. (4 pages)
3. Employee/Contractor Information/Emergency Sheet. (with Email address)
4. Employment Eligibility Verification. (9 pages)
5. Form W-4. (for employee only, 2 pages)
6. Florida Criminal History/Finger Print Card -Request from GFR Office (FBI, fee paid by GFR)
7. Affidavit of Good Moral Character. (2 pages, notarized)
8. GFR Philosophy, practices and expectations
9. Exercise Equipment _Orientation Use and Safety
10. Non-compete Clause and Confidentiality Agreement.
11. HIPAA Information.
12. Agreement regarding use of cell phone while driving
13. Automobile Insurance Agreement
14. GFR Policy and Procedure Manual [located at main office]
15. GFRNew Employee Check list
16. Timesheet / Payroll agreement (signed)
17. GFRAdmin. Time Sheet.
18. Resume.
19. Copy of Drivers License
20. Copy of Social Security Card.
21. CPR - for Technicians
22. Copy of Current Auto Insurance Card
23. Copy of Degree or Diploma awarded.
BOLD: Employee must provide.

Office / Therapist Staff Employee

This agreement, made and entered into this day of , by and between Ginger Fitness & Rehabilitation, inc., a Florida Corporation, hereinafter referred to as (GFR), and , Office / Therapist Staff, hereinafter referred to as Employee.

This is an employee-employer relationship. Taxes are withheld as required by federal and state law. The rate is $ / hour, on an as needed, on-call basis, and flexible schedule. There is no guarantee of hours due to fluctuation of patient case load. There is no benefit of holiday / vacation, or health insurance. Other benefits may be given in the year, at the discretion of GFR.

(initial) I understand that I am in a trial period for 3 months, including pending my background and credentials check. Ior GFR can decide to terminate any time.

Employee agrees to abide by all the requirements set forth, and understand that any breach of conduct or lack of cooperation with company philosophy and requirements may automatically terminate the relationship with GFR.

1. GFR's company philosophy: Getting to the Root of the Problem ©

Promoting proper health choices by first finding the "root" of the problem. To treat naturally and scientifically, to allow the body sufficient time to recover and improve. Each patient/client is encouraged to look at his/her health project as a long term habit. Just as one has to eat well to survive well, one also has to exercise correctly to improve his/her health and feeling of well-being. When the Ginger root is healthy, then the effects are manifested in the healthy plant and beautiful flower.
Employees are expected to lead by example, to make all attempts to live and practice good health habits, promote preventive health and proper rehabilitation, and grow personally and professionally, by continually updating knowledge and becoming active in their community and professional circles.

2. Professionalism - Employees are expected to demonstrate the following:

Practice good citizenship as demonstrated by good character, willingness to help others, etc.
Proactive at work: initiating steps to improve the work environment, seeking ways to improve relationship with fellow employees, seeking solutions to improve company operations, providing constructive ideas to improve self and company.
Pledge to exercised at least 2x/wk (list activities):
Good interpersonal skills, proper attire and professionalism during community and client visits (pants/skirt/dress length below knee, dress shorts, clean closed toe shoes, White or Dark Forest Green Polo, clothing do not reveal undergarments; tidy hair without hiding eyes, proper eye contact and clear directions given to patient during each session; good oral and other personal hygiene.)
Work quickly and efficiently, uses time in a constructive manner. Each employee is responsible to greet each patient with a smile and positive affirmations. Each employee is responsible with the maintenance and upkeep of each clinic, to include: (wiping down equipment after each treatment, cleaning restrooms, waiting area, laundry, office supplies) See clinic maintenance check list.

Employee Signature: Position Title Date:
Sharman Atkin, Administrator signature: Date:

Addendum

Employee input: hand-write 2-3 paragraphs about why you are a Therapis/Therapist Assistant/Clinic/office staff and what projects do you want to see happening in the PT professional community and in the general community where you live.

Documents:
o Current FL License: #, expiration date:
o CPR: expiration date:
o Driver's license #
o Auto insurance#: , insurance company:
o Professional Liability insurance:
o SSN #:
o W9
o Application/ resume
o 2 letters of recommendation:
o
o Affidavit of Good Moral Character
o Florida Abuse Background Check
o AIDS update
o Current PPD results
o Hep B Vaccine
o Acknowledgement of Company Policy and Procedure Manual
o HIPAA Training- GFR form and certificate of training
o Non-compete clause/ Confidentiality Agreement
o
o Local Records check: date
o Application for Medicare:
o 8551(Individual) and 855R (Reassignment of Benefit): date sent
o Medicaid:
o Other insurance:

Employee/Contractor Information/Emergency Sheet

(Will be kept confidential and used for emergency purposes only)

Employment/Contractor Start date: End date:
Name:
DOB: SSN: Gender: Male Female
Address:
Email Address:
Home #: Cell #: Other #:

Contact in case of Emergency

Name 1:

Relationship:

Address:

Phone:

Alternate Phone:

Name 2:

Relationship:

Address:

Phone:

Alternate Phone:

Medical Information

HospitaI Preference

Medical Doctor's Name:

Phone

Specialists (list):

Allergic Reactions:

Medications:

Health Issues/Precautions:

SIGNATURE

DATE

Instructions for Employment Eligibility Verification

Department of Homeland Security
U.S. Citizenship and Immigration Services

Read all instructions carefully before completing this form.

Anti-Discrimination Notice. It is illegal to discriminate against any work-authorized individual in hiring, discharge, recruitment or referral for a fee, or in the employment eligibility verification (Form I-9 and E-Verify) process based on that individual's citizenship status, immigration status or national origin. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. For more information, call the Office of Special Counsel for Immigration-Related Unfair Employment Practices (OSC) at 1-800-255-7688 (employees), 1-800-255-8155 (employers), or 1-800-237-2515 (TDD), or visit www.justice.gov/crt/about/osc.

What Is the Purpose of This Form?

Employers must complete Form I-9 to document verification of the identity and employment authorization of each new employee (both citizen and noncitizen) hired after November 6, 1986, to work in the United States. In the Commonwealth of the Northern Mariana Islands (CNMI), employers must complete Form I-9 to document verification of the identity and employment authorization of each new employee (both citizen and noncitizen) hired after November 27, 2011. Employers should have used Form I-9 CNMI between November 28,2009 and November 27,2011.

General Instructions

Employers are responsible for completing and retaining Form I-9. For the purpose of completing this form, the term "employer" means all employers, including those recruiters and referrers for a fee who are agricultural associations, agricultural employers, or farm labor contractors. Form I-9 is made up of three sections. Employers may be fined if the form is not complete. Employers are responsible for retaining completed forms. Do not mail completed forms to U.S. Citizenship and Immigration Services (USCIS) or Immigration and Customs Enforcement (ICE).

Section 1. Employee Information and Attestation

Newly hired employees must complete and sign Section 1 of Form I-9 no later than the first day of employment. Section I should never be completed before the employee has accepted a job offer. Provide the following information to complete Section 1:

Name: Provide your full legal last name, first name, and middle initial. Your last name is your family name or surname. If you have two last names or a hyphenated last name, include both names in the last name field. Your first name is your given name. Your middle initial is the first letter of your second given name, or the first letter of your middle name, if any.
Other names used: Provide all other names used, if any (including maiden name). If you have had no other legal names, write "N/A."
Address: Provide the address where you currently live, including Street Number and Name, Apartment Number (if applicable), City, State, and Zip Code. Do not provide a post office box address (P.O. Box). Only border commuters from Canada or Mexico may use an international address in this field.
Date of Birth: Provide your date of birth in the mm/dd/yyyy format. For example, January 23, 1950, should be written as 01/23/1950.
U.S. Social Security Number: Provide your 9-digit Social Security number. Providing your Social Security number is voluntary. However, if your employer participates in E-Verify, you must provide your Social Security number.
E-mail Address and Telephone Number (Optional): You may provide your e-mail address and telephone number. Department of Homeland Security (DHS) may contact you if DHS learns of a potential mismatch between the information provided and the information in DHS or Social Security Administration (SSA) records. You may write "N/A" if you choose not to provide this information.

All employees must attest in Section 1, under penalty of perjury, to their citizenship or immigration status by checking one of the following four boxes provided on the form:

1. A citizen of the United States
2. A noncitizen national of the United States: Noncitizen nationals of the United States are persons born in American Samoa, certain former citizens of the former Trust Territory of the Pacific Islands, and certain children of noncitizen nationals born abroad.
3. A lawful permanent resident: A lawful permanent resident is any person who is not a U.S. citizen and who resides in the United States under legally recognized and lawfully recorded permanent residence as an immigrant. The term "lawful permanent resident" includes conditional residents. If you check this box, write either your Alien Registration Number (A-Number) or USCIS Number in the field next to your selection. At this time, the USCIS Number is the same as the A-Number without the "A" prefix.
4. An alien authorized to work: If you are not a citizen or national of the United States or a lawful permanent resident, but are authorized to work in the United States, check this box. If you check this box:

a. Record the date that your employment authorization expires, if any. Aliens whose employment authorization does not expire, such as refugees, asylees, and certain citizens of the Federated States of Micronesia, the Republic of the Marshall Islands, or Palau, may write "N/A" on this line.
b. Next, enter your Alien Registration Number (A-Number)/USCIS Number. At this time, the USCIS Number is the same as your A-Number without the "A" prefix. If you have not received an A-Number/USCIS Number, record your Admission Number. You can find your Admission Number on Form I-94, "Arrival-Departure Record," or as directed by uscis or U.S. Customs and Border Protection (CBP).

(1) If you obtained your admission number from CBP in connection with your arrival in the United States, then also record information about the foreign passport you used to enter the United States (number and country of issuance).
(2) If you obtained your admission number from uscis within the United States, or you entered the United States without a foreign passport, you must write "N/A" in the Foreign Passport Number and Country of Issuance fields.

Sign your name in the "Signature of Employee" block and record the date you completed and signed Section I. By signing and dating this form, you attest that the citizenship or immigration status you selected is correct and that you are aware that you may be imprisoned and/or fined for making false statements or using false documentation when completing this form. To fully complete this form, you must present to your employer documentation that establishes your identity and employment authorization. Choose which documents to present from the Lists of Acceptable Documents, found on the last page of this form. You must present this documentation no later than the third day after beginning employment, although you may present the required documentation before this date.

Preparer and/or Translator Certification
The Preparer and/or Translator Certification must be completed if the employee requires assistance to complete Section 1 (e.g., the employee needs the instructions or responses translated, someone other than the employee fills out the information blocks, or someone with disabilities needs additional assistance). The employee must still sign Section 1.

Minors and Certain Employees with Disabilities (Special Placement)
Parents or legal guardians assisting minors (individuals under 18) and certain employees with disabilities should review the guidelines in the Handbook for Employers: Instructions for Completing Form I-9 (M-274) on www.uscis.gov/ I-9Central before completing Section 1. These individuals have special procedures for establishing identity if they cannot present an identity document for Form I-9. The special procedures include (1) the parent or legal guardian filling out Section 1 and writing "minor under age 18" or "special placement," whichever applies, in the employee signature block; and (2) the employer writing "minor under age 18" or "special placement" under List B in Section 2.

Section 2. Employer or Authorized Representative Review and Verification

Before completing Section 2, employers must ensure that Section 1 is completed properly and on time. Employers may not ask an individual to complete Section I before he or she has accepted a job offer.

Employers or their authorized representative must complete Section 2 by examining evidence of identity and employment authorization within 3 business days of the employee's first day of employment. For example, if an employee begins employment on Monday, the employer must complete Section 2 by Thursday of that week. However, if an employer hires an individual for less than 3 business days, Section 2 must be completed no later than the first day of employment. An employer may complete Form I-9 before the first day of employment if the employer has offered the individual a job and the individual has accepted.

Employers cannot specify which document(s) employees may present from the Lists of Acceptable Documents, found on the last page of Form I-9, to establish identity and employment authorization. Employees must present one selection from List A OR a combination of one selection from List B and one selection from List C. List A contains documents that show both identity and employment authorization. Some List A documents are combination documents. The employee must present combination documents together to be considered a List A document. For example, a foreign passport and a Form I-94 containing an endorsement of the alien's nonimmigrant status must be presented together to be considered a List A document. List B contains documents that show identity only, and List C contains documents that show employment authorization only. If an employee presents a List A document, he or she should not present a List B and List C document, and vice versa. If an employer participates in E-Verify, the List B document must include a photograph.

In the field below the Section 2 introduction, employers must enter the last name, first name and middle initial, if any, that the employee entered in Section I. This will help to identify the pages of the form should they get separated.

Employers or their authorized representative must:

1. Physically examine each original document the employee presents to determine if it reasonably appears to be genuine and to relate to the person presenting it. The person who examines the documents must be the same person who signs Section 2. The examiner of the documents and the employee must both be physically present during the examination of the employee's documents.

2. Record the document title shown on the Lists of Acceptable Documents, issuing authority, document number and expiration date (if any) from the original document(s) the employee presents. You may write "N/A" in any unused fields.
If the employee is a student or exchange visitor who presented a foreign passport with a Form I-94, the employer should also enter in Section 2:
a. The student's Form I-20 or DS-2019 number (Student and Exchange Visitor Information System-SEVIS Number); and the program end date from Form I-20 or DS-2019.

3. Under Certification, enter the employee's first day of employment. Temporary staffing agencies may enter the first day the employee was placed in a job pool. Recruiters and recruiters for a fee do not enter the employee's first day of employment.

4. Provide the name and title of the person completing Section 2 in the Signature of Employer or Authorized Representative field.

5. Sign and date the attestation on the date Section 2 is completed.

6. Record the employer's business name and address.

7. Return the employee's documentation.

Employers may, but are not required to, photocopy the document(s) presented. If photocopies are made, they should be made for ALL new hires or reverifications. Photocopies must be retained and presented with Form I-9 in case of an inspection by DHS or other federal government agency. Employers must always complete Section 2 even if they photocopy an employee's document(s). Making photocopies of an employee's document(s) cannot take the place of completing Form I-9. Employers are still responsible for completing and retaining Form I-9.

Unexpired Documents Generally, only unexpired, original documentation is acceptable. The only exception is that an employee may present a certified copy of a birth certificate. Additionally, in some instances, a document that appears to be expired may be acceptable if the expiration date shown on the face of the document has been extended, such as for individuals with temporary protected status. Refer to the Handbook for Employers: Instructions for Completing Form I-9 (M-274) or I-9 Central (www.uscis.gov/I-9Central) for examples.

Receipts

If an employee is unable to present a required document (or documents), the employee can present an acceptable receipt in lieu of a document from the Lists of Acceptable Documents on the last page of this form. Receipts showing that a person has applied for an initial grant of employment authorization, or for renewal of employment authorization, are not acceptable. Employers cannot accept receipts if employment will last less than 3 days. Receipts are acceptable when completing Form I-9 for a new hire or when reverification is required.

Employees must present receipts within 3 business days of their first day of employment, or in the case of reverification, by the date that reverification is required, and must present valid replacement documents within the time frames described below.

There are three types of acceptable receipts:

1. A receipt showing that the employee has applied to replace a document that was lost, stolen or damaged. The employee must present the actual document within 90 days from the date of hire.

2. The arrival portion of Form I-94/I-94A with a temporary 1-551 stamp and a photograph of the individual. The employee must present the actual Permanent Resident Card (Form I-551) by the expiration date of the temporary 1-551 stamp, or, if there is no expiration date, within 1 year from the date of issue.

3. The departure portion of Form I-94/I-94A with a refugee admission stamp. The employee must present an unexpired Employment Authorization Document (Form I-766) or a combination of a List B document and an unrestricted Social Security card within 90 days.

When the employee provides an acceptable receipt, the employer should:

1. Record the document title in Section 2 under the sections titled List A, List B, or List C, as applicable.

2. Write the word "receipt" and its document number in the "Document Number" field. Record the last day that the receipt is valid in the "Expiration Date" field.

By the end of the receipt validity period, the employer should:

1. Cross out the word "receipt" and any accompanying document number and expiration date.

2. Record the number and other required document information from the actual document presented.

3. Initial and date the change

See the Handbook for Employers: Instructions for Completing Form I-9 (M-274) at www.uscis.gov/I-9Central for more information on receipts.

Section3. Reverification and Rehires

Employers or their authorized representatives should complete Section 3 when reverifying that an employee is authorized to work. When rehiring an employee within 3 years of the date Form I-9 was originally completed, employers have the option to complete a new Form I-9 or complete Section 3. When completing Section 3 in either a reverification or rehire situation, if the employee's name has changed, record the name change in Block A.

For employees who provide an employment authorization expiration date in Section I, employers must reverify employment authorization on or before the date provided.

Some employees may write "N/A" in the space provided for the expiration date in Section 1 if they are aliens whose employment authorization does not expire (e.g., asylees, refugees, certain citizen of the Federated States of Micronesia, the Republic of the Marshall Islands, or Palau). Reverification does not apply for such employees unless they chose to present evidence of employment authorization in Section 2 that contains an expiration date and requires reverification, such as Form I-766, Employment Authorization Document. Reverification applies if evidence of employment authorization (List A or List C document) present in Section 2 expirces. However, employers should not reverify:
1. U.S citizens and noncitizen nationals; or
2. Lawful permanent residents who presented a Permanent Resident Card(From 1-551) for section 2.
Reverification does not apply to List B documents.
If both Section 1 and Section 2 indicate expiration dates triggering the reverification requirement, the employer should reverify by the earlier date.
For reverification, an employee must present unexpired documentation form either List A or List C showing he or she is still authorized to work. Employers CANNOT require the employee to present a particular document from List A or List C. The employee may choose which document to present.
To complete Section 3, employers should follow these instructions:
1. Complete Block A if an employee's name has change at the time you complete Section 3.
2. Complete Block B with the date of rehire if you rehire an employee within 3 years of the date this form was originally completed, and the employee is still authorized to be employed on the same basis as previously indicated on this form. Also complete the "Signature of Employer or Authorized Representative" block.
3. Complete Block C if:
a. The Employment authorization or employment authorization document of a current employee is about to expire and requires reverification ; or
b. You rehire an employee within 3 years of the date this form was originally complete and his or her employement authorization or employement auhtorization document has expired.(Complete Block B for this employee as well.)
To Complete Block C:
a. Examine either a List A or List C document the employee presents that shows that the employee is currently authorized to work in the United States; and
b. Record the document title, document number, and expiration date (if any).
4. After completing block A,B or C, complete the"Signature of Employer or Authorized Representative" block including the date.
For reverification purposes, employers may either complete Section 3 of new From I-9 or Section 3 of the previously complete Form I-9. Any new pages of Form I-9, completed during reverification must be attached to the employee's original Form I-9. If you choose to complete Section 3 of a new Form I-9, you may attach just the page containing Section 3, with the employee's name entered at the top of the page, to the employee's original Form I-9. If there is a more current version of Form I-9 at the time of reverification, you must complete Section 3 of that version of the form.

What Is the Filing Fee?

There is no fee for completing Form I-9. This form is not filed with USCIS or any government agency. From I-9 must be retained by the employer and made available for inspection by U.S Government officials as specified in the "USCIS Act Privacy Statement" below.

USCIS Forms and Information

For more detailed information about completing From I-9. employers and employees should refer to the Handbook for Employers: Instructions for Completing Form I-9 (M-274) -
You can also obtain information about Form I-9 form the USCIS Web site at www.uscis.gov/I-9Central by e-mailing USCIS atI-9Central@dbs.gov, or by calling 1-888-464-4218. For TDD(hearing impaired), call 1-877-875-6028.
To obtain USCIS form or the Hanbook for Employers, you can download them from the USCIS Web site at www.uscis.gov/forms.You may order USCIS form by calling our toll-free number at 1-800-870-3676.You may also obtain forms and information by contacting the USCIS National Customer Service Center at 1-800-375-5283. For TDD(hearing impaired), call 1-800-767-1833.
Information about E-Verify, a free and voluntary program that allows participating employers to electronically verify the employment eligibility of their new ly hired employees, can be obtained from the USCIS Web size at www.dhs.gov/E-Verify, by e-mailing USCIS at E-Verify@dhs.gov or by calling 1-888-464-4218. For TDD(hearing impaired), call 1-877-875-6028.
Employees with questions about Form I-9 and/or E-Verify can reach the USCIS employee hotline by calling 1-888-897-7781. For TDD(hearing impaired), call 1-877-875-6028.

Photocopying and Retaining Form I-9

A blank From I-9 may be reproduced, provided all sides are copied. The instructions and Lists of Acceptable Documents must be available to all employees completing this form. Employers must retain each employee's complete Form I-9 for as long as the individual works for the employer.Employers are required to retain the pages of the form on which the employee and employer enter data. If copies of documentation presented by the employee are made, those copies must also be kept with the form. Once the individual's employment ends, the employer must retain this form for either 3 years after the date of hire or 1 year after the date employment ended, whichever is later.
Form I-9 may be signed and retained electronically, in compliance with Department of Homeland Security regulations at 8 CFR 274a.2.

USCIS Privacy Act Statement

AUTHORITIES: the authority for collecting this information is the Immigration Reform and Control Act of 1986, Public law 99-603(8 USC 1324a).
PURPOSE: This information is collected by employers to comply with the requirements of the Immigration Reform and Control Act of 1986. This law requires that employers verify the identity and employment authorization of individuals they hire for employment to preclude the unlawful hiring, or recruiting or referring for e fee, of aliens who are not authorized to work in the United States.
DISCLOSURE: Submission of the information required in this form is voluntary. However, failure of the employer to ensure proper completion of this form for each employee may result in the imposition of civil or criminal penalties. In addition, employing individuals knowing that they are unauthorized to work in the United States may subject the employer to civil and/or criminal penalties.
ROUTINE USES: This information will be used by employers as a record of their basis for determining eligibility of an employee to work in the United States. The employer will keep this form and make it available for inspection by authorized officials of the Department of Homeland Security, Department of Labor, and Office if Special Counsel for Immigration-Related Unfair Employment Practices.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information unless it display a currently valid OMB control number. The public reporting burden for this collection of information is estimated at 35 minutes per response, including the time for reviewing instruction and completing and retaining the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Divison, Office of Policy and Strategy, 20 Massachusetts Avenue NW, Washington, DC 20529-2140; OMB No. 1615-0047.Do not mail your complete Form I-9 to this address.

Employment Eligibility Verification

Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS

Form I-9S
OMB No. 1615-0047
Expires 03/31/2016

START HERE.

Read instructions carefully before completing this form. The Instruction must be available during completion of this form.

ANTI-DISCRIMINATION NOTICE:

It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of FormI-9 no later then the first day of employment, but not before accepting a job offer.)
Last Name(Family Name) First Name(Given Name) Middle Initial		Other Name Used(if any)
Address (Street Number and Name)		Apt.Number
City or Town	State	Zip Code
Date of Birth(mm/dd/yyyy)	U.S. Social Security Number
E-mail Address		Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of the form.
I attest, under penalty of perjury, that I am(check one of the following)
A citizen the United States.
A noncitizen national of the United States(see instructions)
A lawful permanent resident(Alien Registration Number/USCIS Number):
An alien authorized to work until(expiration date, if applicable, mm/dd/yyyy) . Some aliens may write "N/A" in this filed.(see instructions)
For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form I-94 Admission Number:

1. Alien Registration Number/USCIS Number:
OR
2. Form I-94 Admission Number:
If you obtained your admission Number from CBP in connection with your arrival in the United States, include the following:
Foreign Passport Number
Country of Issuance
Some aliens may write "N/A" on the Foreign Passport Number and Country of Issuance fields.(see instructions)

3-D Barcode
Do Not Write in this Space

Signature of Employee:

Date(mm/dd/yyyy):

Preparer and/or Translator Certification(To be completed and signed if Section 1 prepared by a person other than the employee.)

I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and corect.

Signature of Preparer or Translator:	Date(mm/dd/yyyy):
Last Name(Family Name)	First Name(Given Name)
Address(Street Number and name)	City or Town
States	Zip Code

Employer Completes Next Page

Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine once document from List A OR examine a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents" on the next page of this form. For each document you review, record the following information: document title, issuing authority, document number, and expiration date, if any.)

Employee Last Name, First NAme and middle Initial from Section1:

List A
Identity and Employment Authorization

List B
Identity

AND

List C
Employment Authorization

Document Title:	Document Title:	Document Title:
Issuing Authority:	Issuing Authority:	Issuing Authority:
Document Number:	Document Number:	Document Number:
Expiration Date(if any)(mm/dd/yyyy):	Expiration Date(if any)(mm/dd/yyyy):	Expiration Date(if any)(mm/dd/yyyy):
Document Title Issuing Authority: Document Number: Expiration Date (if any)(mm/dd/yyyy): Document Title Issuing Authority: Document Number: Expiration Date (if any)(mm/dd/yyyy):	3-D Barcode Do You Write in This Space

Certification
I attest, under penalty of perjury, that(1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee ia authorized to work in the United States.
The employee's first day of employment(mm/dd/yyyy) (See instructions for exemptions.)

Signature of Employer or Authorized Representative	Date(mm/dd/yyyy)
Title of Employer or Authorized Representative
Last Name(Family Name)	First Name(Given Name)
Employer's Business or Organization Name
Employer's Business or Organization Address(Street Number and Name)	City or Town
State	Zip Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A.New Name (if applicable): Last Name(Family Name): Frist Name(Given Name): Middle Initial	B. Date of Rehire(if applicable)(mm/dd/yyyy):

C.If employee's previous grant of employment authorization has expired, porvide the information for the document from List A or List C the employee presented that establishes current employment authorization in the space provided below.
Document Title:	Document Number:	Expiration Date(if any)(mm/dd/yyyy):

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to the individual.

Signature of Employer or Authorized Representative:

Date (mm/dd/yyyy):

Print Name of Employer or Authorized Representative:

LIST OF ACCEPTABLE DOCUMENTS - All documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C

LIST A Documents that Establish Both Identity and Employment Authorization

U.S Passport or U.S Passport Card
Permanent Resident Card or Alien Registration Receipt Card (Form I-551)
Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa
Employment Authorization Document that contains a photograph (Form I-766)
For a nonimmigrant alien authorized to work for a specific employer because of his or her status:
a. Foreign passport; and
b. Form I-94 or Form I-94A that has the following:
(1) The same name as the passport; and
(2) An endorsement of the ailen's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.
Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or form I-94A indicating noimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

LIST B Documents that Establish Identity

Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date or birth, gender, height, eye color, and address
ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name. date of birth, gender, height, eye color, and address
School ID card with a photograph
Voter's registration card
U.S Military card or draft record
Military dependent's ID card
U.S Coast Guard Merchant Mariner Card
Native American tribal document
Driver's license issued by a Canadian government authority

For persons under age 18 who are unable to present a document listed above:
School record or report card
Clinic, doctor, or hospital record
Day-care or nursery school record

AND

LIST C Document that Establish Employment Authorization

A Social Security Account Number card, unless the card includes one of the following restrictions:
(1) NOT VALID FOR EMPLOYMENT
(2) VALID FOR WORK ONLY WITH INS AUTHORIZATION
(3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION
Certification of Birth Abroad issued by the Department of State (Form FS-545)
Certification of Report of Birth issued by the Department of State (Form FS-1350)
Original or certified copy of birth certificate issued by a State, country, municipal authority, or territory of the United States bearing an official seal
Native American tribal document
U.S Citizen ID Card (Form I-197)
Identification Card for Use of Resident citizen in the United States (Form I-197)
Employment authorization document issued by the Department of Homeland Security

Illustrations of many these documents appear in Part 8 of the Handbook for employers (M-274).

Refer to Section 2 of the instructions, titled "Employer or Authorized Representative Review and Verification," for more information about acceptable receipts

Form W-4 (2014)

Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. If you are exempt complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2014 expires February 17, 2015. See Pub. 505, Tax Withholding and Estimated Tax.

Note. If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $1,000 and includes more than $350 of unearned income (for example, interest and dividends).

Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee:

Is age 65 or older,
Is blind, or
Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return.

The exceptions do not apply to supplemental wages greater than $1,000,000.

Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustment to income, or two-earners/multiple jobs situations.

Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. for regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information

Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances.

Nonwage income. If you have a large amount of nonwage income, such as interest and dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P.

Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details.

Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how amount you are having withheld compares to your projected total tax for 2014. See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married).

Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at www.irs.gov/w4

Personal Allowances Worksheet (Keep for your records)

Enter "1" for yourself if no one else can claim you as dependent

Enter "1" if :

You are single and have only one job, or
You are married, have only one job, and your spouse does not work; or
Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less.

Enter "1" for your spouse. But, you may choose to enter "-0-" if you are married and have either a working spouse or more than one job. (Entering "-0-" may help you avoid having too little tax withheld.)

Enter number of dependents (other than your spouse or yourself) you will claim on your tax return

Enter "1" if you will file as head of household on your tax return (see conditions under Head of household above )

Enter "1" if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit
(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)

Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

If your total income wil be less than $65,000 ($95,000 if married), enter "2" for each eligible child; then less "1" if you have three to six eligible children or less "2" if you have seven ot more eligible children.
If your total income will be between $65,000 and $84,000 ($95,000 and $119,000 if married), enter "1" for each eligible child.

Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim in your tax return)

For accuracy, complete all worksheets that apply.

If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2.
If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld.
If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below

Separate here and give Form W-4 to your employer. keep the top part for your record

Form W-4
Department of the Treasury Internal Revenue Service

Employee's Withholding Allowance Certificate

Whether you are entitled to claim a certain number of allowances or exemption from withholding is subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS

OMB No. 1545-0074
2014

1. Your first name and middle initial

Last name

2. Your social security number

Home address (number abd street or rural route)	3. Single Married Married, but withhold at higher Single rate Note. If married, but legally separated, or spouse is a nonresident alien, check the "Single" box.
City or town, state, and ZIP code	4. If your last name differs from that shown on your social security card, check here. you must call 1-800-772-1213 for a replacement card

5. Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2)

6. Additional amount, if any, you want withheld from each paycheck

7. I claim exemption from withholding for 2014, and i certify that I meet both of the following conditions for exemption.

Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.

If you meet both conditions, write "Exempt" here

Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.

Employee's signature (This form is not valid unless you sign it.)

Date:

8. Employer's name and address (Employer: complete lines 8 and 10 only if sending to the IRS)

9. Office code(optional)

10. Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Cat. No. 10220Q

Form W-4 (2014)

Form W-4 (2014)

Page 2

Deductions and Adjustments Worksheet

Note.	Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.
1	Enter an estimate of your 2014 itemized deductions. These include qualifying home mortgage interest, charitable contribution, state and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1950) of your income, and miscellaneous deductions. For 2014, you may have to reduce your itemized deductions if your income is over $305,050 and you are married filing jointly or are a qualifying window(er); $279,650 if you are head of household; $254,200 if you are single and not head of household or a qualifying window(er); or $152,525 if you are married filing separately. See Pub. 505 for details	$
2	Enter: $12,400 if married filing jointly or qualifying window(er) $9,100 if head of household $6,200 if single or married filing separately	$
3	Subtract line 2 from line 1. If zero or less, enter "-0-"	$
4	Enter an estimate of your 2014 adjustments to income and any additional standard deduction (see Pub. 505)	$
5	Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to Withholding Allowances for 2014 Form W-4 worksheet in Pub. 505 )	$
6	Enter an estimate of your 2014 nonwage income (such as dividends or interest)	$
7	Subtract line 6 from line 5. If zero or less, enter "-0-"	$
8	Divide the amount on line 7 by $3,950 and the result here. Drop any fraction
9	Enter the number from the Personal Allowances Worksheet, line H, page 1
10	Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1

Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)

Note.	Use this worksheet only if the instructions under line H on page 1 direct you here
1	Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet)
2	Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than "3"
3	If line 1 is more than or equal to line 2, subtract line from line 1. Enter the result here (if zero, enter "-0-") and on Form W-4, line 5, page 1. Do not use the rest of this worksheet
Note.	If line 1 is less than line 2, enter "-0-" on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill.
4	Enter the number from line 2 of this worksheet
5	Enter the number from line 1 of this worksheet
6	Subtract line 5 from line 4
7	Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here	$
8	Multiply line 7 by line 6 and enter the result here. This is additional annual withholding needed	$
9	Divide line 8 by the number of pay periods remaining in 2014. For example, divide by 25 if you are paid every two weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2014. Enter the result here and on form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck	$

Table 1
Married Filing Jointly		All Others
If wages from LOWEST paying job are-	Enter on line 2 above	If wages from LOWEST paying job are-	Enter on line 2 above
$0 - $6,000	0	$0 - $6,000	0
6,001 - 13,000	1	6,001 - 16,000	1
13,001 - 24,000	2	16,001 - 25,000	2
24,001 - 26,000	3	25,001 - 34,000	3
26,001 - 33,000	4	34,001 - 43,000	4
33,001 - 43,000	5	43,001 - 70,000	5
43,001 - 49,000	6	70,001 - 85,000	6
49,001 - 60,000	7	85,001 - 110,000	7
60,001 - 75,000	8	110,001 - 125,000	8
75,001 - 80,000	9	125,001 - 140,000	9
80,001 - 100,000	10	140,001 and over	10
100,001 - 115,000	11
115,001 - 130,000	12
130,001 - 140,000	13
140,001 - 150,000	14
150,001 and over	15

Table 2
Married Filing Jointly		All Others
If wages from HIGHEST paying job are-	Enter on line 7 above	If wages from HIGHEST paying job are-	Enter on line 7 above
$0 - $74,000	$590	$0 - $37,000	$590
74,001 - 130,000	990	37,001 - 80,000	990
130,001 - 200,000	1,110	80,001 - 175,000	1,110
200,001 - 355,000	1,300	175,001 - 385,000	1,300
355,001 - 400,000	1,380	385,001 and over	1,560
400,001 - and over	1,560

Privacy Act Paperwork Reduction Act Notice. WE ask for the information on this form to carry out the Internal Revenus laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it ti the Department of Justice for civil and criminal litigation; to cities, states, the Districts of Columbia, and U.S commonwealths and possessions for use in administering their tax laws; and to the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revende law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

AFFIDAVIT OF GOOD MORAL CHARACTER FOR PURPOSES RELEVANT TO SECTIONS 400.512, FLORIDA STATUTES

(To be signed by alternate administrators and home health agency staff that do not have level 1 screening results yet. The original must be kept in the provider's personnel files.)

Authority: As stated in 400.512, Florida Statutes (F.S.), "The agency shall require employment or contractor screening as provided in chapter 435, using the level 1 standards for screening set forth in that chapter, for home health agency personnel;..." State rule 59A-8.0185, Florida Administrative Code, requires that any newly hired employee, working in a probationary status pending the results of the background screening, complete this form.

Effective October 1, 2009, additional criminal offenses have been added to those prohibited as listed in subsection 408.809(5), F.S.

STATE OF: COUNTY OF:

Before me this day personally appeared who, being duly sworn, deposes and says:

As an applicant for employment with

I hereby attest to meeting the requirements for employment that I am of good moral character in that I have not been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under any of the following provisions of the Florida Statutes or under any similar statute or ordinance of another jurisdiction:

Criminal offenses found in section 435.03,F.S.

(a) Section 393.135, F.S., relating to sexual misconduct with certain developmentally disabled clients and reporting of such sexual misconduct.
(b) Section 394.4593, F.S., relating to sexual misconduct with certain mental health patients and reporting of such sexual misconduct.
(c) Section 415.111, F.S., relating to abuse, neglect, or exploitation of a vulnerable adult.
(d) Section 782.04, F.S., relating to murder.
(e) Section 782.07, F.S., relating to manslaughter, aggravated manslaughter of an elderly person or disabled adult, or aggravated manslaughter of a child.
(f) Section 782.071, F.S., relating to vehicular homicide.
(g) Section 782.09, F.S., relating to killing of an unborn child by injury to the mother.
(h) Section 782.011, F.S., relating to assault, if the victim of the offense was a minor.
(i) Section 784.021, F.S., relating to aggravated assault.
(j) Section 784.03, F.S., relating battery, if the victim of the offense was a minor.
(k) Section 784.045, F.S., relating to aggravated battery.
(l) Section 787.01, F.S., relating to kidnapping.
(m) Section 787.02, F.S., relating to false imprisonment.
(n) Section 794.011, F.S., relating to sexual battery.
(o) Former s. 794.041, F.S., relating to prohibited acts of persons in familial or custodial authority.
(p) Chapter 796, F.S., relating to prostitution.
(q) Section 798.02, F.S., relating to lewd and lascivious behavior.
(r) Chapter 800, relating to lewdness and indecent esposure.
(s) Section 806.01, F.S., relating to arson.
(t) Chapter 812, F.S., relating to theft, robbery, and related crimes, if the offense was a felony.
(u) Section 817.563, F.S., relating to fraudulent sale of controlled substances, only if the offense was a felony.
(v) Section 825.102, F.S., relating to abuse, aggravated abuse, or neglect of an elderly person or disabled adult.
(w) Section 825.1025, F.S., relating to lewd or lascivious offenses commited upon or in the presence of an elderly person or disabled adult.
(x) Section 825.103, F.S., relating to exploitation of an elderly person or disabled adult, if the offense was a felony.
(y) Section 826.04, F.S., relating to incest.
(z) Section 827.03, F.S., relating to child abuse, aggravated child abuse, or neglect of a child.
(aa) Section 827.04, F.S., relating to contributing to the delinquency or dependency of a child.
(bb) Former s.827.05, F.S., relating to negligent treatment of children.
(cc) Section 827.071, F.S., relating to sexual performance by a child.
(dd) Chapter 847, F.S., relating to obscene literature.
(ee) Chapter 893, F.S., relating to drug abuse prevention and control, only if the offense was a felony or if any other person involved in the offense was a minor.
(ff) Section 916.0175, F.S., relating to sexual misconduct with certain forensic clients and reporting of such sexual misconduct.

(a) For employees or employers licensed or registered pursuant to chapter 400 or chapter 429, and for employees and employers of developmental disabilities institutions as defined in s. 393.063, intermediate care facilities for the developmentally disabled as defined in s. 400.960, and mental health treatment facilities as defined in s. 394.455, meets the requirements of this chapter.
(b) Has not commited an act that constitutes domestic violence as defined in s. 741.28, F.S.

Criminal offences found in section 408.809(5), F.S

(a) Any authorizing statutes, if the offense was a felony.
(b) This chapter, if the offense was a felony.
(c) Section 409.920, relating to Medicaid provider fraud, if the offense was a felony.
(d) Section 409.9201, relating to Medicaid fraud, if the offense was a felony.
(e) Section 741.28, relating to domestic violence.
(f) Chapter 784, relating to assault, battery, and culpable negligence, if the offense was a felony.
(g) Section 810.02, relating to burglary.
(h) Section 817.034, relating to fraudulent acts through mail, wire, radio, electromagnetic, photoelectronic, or photooptical systems.
(i) Section 817.234, relating to false and fraudulent insurance claims.
(j) Section 817.505, relating to patient brokering.
(k) Section 817.568, relating to criminal use of personal identification information.
(l) Section 817.60, relating to obtaining a credit cards through fraudulent means.
(m) Section 817.61, relating to fraudulent use of credit cards, if the offense was a felony.
(n) Section 831.01, relating to forgery.
(o) Section 831.02, relating to uttering forged instruments.
(p) Section 831.07, relating to forging bank bills, checks drafts, or promissory notes.
(q) Section 831.09, relating to uttering forged bank bills, checks, drafts, or promissory notes.
(r) Section 831.30, relating to fraud in obtaining medicinal drugs.
(s) Section 831.31, relating to the sale, manufacture, delivery, or possession with the intent to sell, manufacture, or deliver any counterfeit controlled subtance, if the offense was a felony.

SIGN EITHER (1) OR (2) BELOW:

(1) Under the penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true to the best of my knowledge and belief.

AFFIANT

(2) To the best of my knowledge and belief, my record may contain one of the foregoing disqualifying acts of offenses.

AFFIANT

This person is personally known to me or produced the following identification

Sworn to and subscribed before me this day ofMonth/Year

Notary State Seal:

Notary Public (Type or Print Name)

Notary Public (Signature)

My Commission Expires

Ginger as a philosophy of treatment -
- Promote proper health choices by first finding the "root" of the problem. Treat naturally and scientifically, to allow the body sufficient time to recover and improve. Each patient/client is encouraged to look at his/her health project as a long term habit. Just as one has to eat well to survive well, one also has to exercise correctly to improve his/her health and feeling of well-being. When the Ginger root is healthy, then the effects are manifested in the healthy plant and beautiful flower.
Ginger Fitness and Rehabilitation, Inc * Rehabilitation for -> Newborns- Adults
- Neurology * Cardio Pulmonary
- Orthopedics: Post surgical care * Osteoporosis * Arthritis
- Performing Arts Evaluation
- Wound Care
- Women's Health: Prenatal/Postpartum/Post surgical care
- Men / Woman: Pelvic Floor
- Company / Individual consultation
- Community planning/ Equipment consultation
Life approach: Positive attitude, lifting up and helping each other.
Hard work ethics -
- Positive communication to patients, staff
High work expectations -
- Arrive to clinic 15 minutes before scheduled patients to prepare office (see open/close procedures)
- No personal calls/texting while treating patients.
- Assist other staff members (office or therapist)
Office ...
- Wipe down equipment after each use
- Clean office, therapist room, treatment areas, bathrooms, remove garbage, wash and fold linens, vacuum, sweep and mop,
- Check office and PT supplies - notify appropriate staff for ordering
Scheduling - Elite Scheduler
- Temporary log in / PW: / (each person has own)
- Color codes for each clinic *(Evaluation, Update, Treatment)
  - Wesley Chapel (SG) Brown
  - Busch Blvd (TT) Turquoise
  - Linebaugh (LB) Green
Receptionist work: Assist Answering phones, scheduling, faxing, copying, scanning, filing, cleaning, pick up mail
Clinical: students/PT tech:
- Safety: safe transfers, use of exercise machines and treatment machines, wellness
Dress codes:
- Showered, clean clothing, no strong colognes or perfumes
- GFR or collegiate polo's, comfortable slacks (no shorts, no jeans), clean tennis shoes or closed toed shoes with socks. Long hair pulled back. No undergarments showing. It does not look hygienic to go barefoot (socks ok) when we step up/down mats.

Employee Name Print

Employee Signature Date

Exercise Equipment _ Orientation Use and Safety

** DO NOT allow children or adults who are not patients to use any exercise machines **
** DO NOT allow them to play on any PT equipment, including weights and therapy balls **

TREADMILL - Begin with Power off / lowest incline to 0
- Place safety belt (martial arts belt) on patient around waist firmly
- Wrap emergency band firmly around wrist or waist
- In Emergency pull out this band
- DO NOT allow children or adults who are not patients to use any exercise machines. Hide the emergency band where they can't get to, so they cannot activate treadmill.
- Start treadmill on lowest speed 0.5
- Increase speed and increase incline [per Physical Therapist direction]
- Stand holding on to patient by safety belt firmly [depends on patient. PT will give directions]
- Decrease speed and decrease incline for cool down
- Stop treadmill
- Assist patient off the treadmill if needed
- Patients can walk sideways, backwards, according to rehab needs with supervision.
BIOSTEP: - Begin with Power off
- Turn and Pivot the seat by lever so patient can sit on seat
- Turn the seat facing the pedals
- Adjust seat forward or backward (knees should be slightly flexed, not hyperextended. Feet should be as flat on pedals as possible)
- Set the Weight, time and/or program level {level determine by PT}
- When patient starts to pedal, the machine will calculate time, steps and intensity for duration
- When patient is done, assist out of chair. Turn left or right to pivot the chair.
- Assist patient off the biostep if needed.
Stepper: - Start and Reset if already programmed
Abcoaster:
- Be sure pt is using it slowly with control, not quickly up/down.
- Pt must pull platform all the way past the marker point for counter to count and move through full ROM.
- Pt must SLOWLY lower legs for good controlled eccentric contracts and prevent injury to low back
HIVAMAT:
- Always recharge machine after you are done
- Always wear gloves on both hands, so you don't inadvertently shock pt.
- (Time Intervals , , )
Ultrasound Machine:
- Caution: do not allow head of US to be removed from touching skin surface while machine is running, this will destroy the US head crystals.
TENS/ Iontophoresis:
- Caution: do not pull or allow for electrodes to be pulled inadvertently during treatment or pt will be shocked.
- Staff will be given specific instructions at time of treatment.
- Check skin condition prior and after treatment to be sure there is no irritation.

Employee Name Print
Employee Signature Date

* original - personnel file

Ginger Fitness & Rehabilitation, Inc.
Employees, Contractors, Students, Volunteers
Non-complete Clause and Confidentiality Agreement

I, , agree to become Employee/Contractor/Volunteer/Students of Ginger Fitness and Rehabilitation, Inc. (GFR) with the following conditions:

Definition: Customers of GFR mean rehabilitative patients, wellness or fitness clients, contracting agencies, and or individual and corporate clients on a consultation basis. Customers can mean corporation entries, agencies, or individuals, or private or community groups.

During the time that I treat or see customers of GFR, I will not try to solicit business for another company.

After I have terminated my relationship with GFR, during a period of 2 years, I will not have business relations with customers of GFR without approval by GFR.

Confident Information includes not only information labeled as such, but also includes, and is not limited to all patient and family information, business information, patient referrals lists, financial and marketing information, patient charts and information, business plans, treatment programs, proprietary materials, and all other information confidental to Ginger Fitness and Rehabilitation, Inc. (GFR).

I understand that during the course of my employment/contracting with GFR, I will receive and have access to confidental information and that such confidental information is owned by GRF. I also understand that the release of such information to third parties would cause damage to GFR. As a result, I agree not to disclose any GFR confidential information which I receive to any third party, except as may be provided by or required by law.

I will also keep all records and information of GFR's contracts confidential, as directed by GFR and those agencies/companies' guideline for contracting.

I will keep all records of my dealings with GFR confidential to myself, without sharing among my family, employees, or third party without prior written authorization from GFR

I will delete from my personal files all patient information, including any paper and electronic copies or communications unless required by law or with GRF's written approval.

This agreement will survive termination of my employment/contracting/volunteer/student clinical with GFR.

Printed Name:
Signature: Date:

Ginger Fitness & Rehabilitation, Inc
HIPAA Confidentiality Agreement

All information relating to patients must be sent only to relevant persons in care of the patient or coordinating patient care. Ask before sending out any types of communication if you have any questions.

Notice of Privacy Practice
See enclosed forms. Use for all new patients. Patients have the right to restrict their privacy information as appropriate for them. All information sent about patients outside of direct patient care or coordination must have patient approval. Contact GFR if you have any questions.

Use of faxes, email, or any other electronic means
Use the statement below or similar for your electronic transmission face sheet or communications:
The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and destroy the material and/or delete the material from any computer.

HIPAA Training Acknowledgement

I have received instructions about HIPAA as relevant to my employment/contracting with Ginger Fitness and Rehabilitation, Inc. (GFR)

As a staff member/contractor for GFR, I recognize that candid and objective discussions of patient conditions are necessary for effective care and management. I further acknowledge the right of each patient to not have personally identifiable medical and / or individual patient. I agree to respect and maintain the confidentiality of all discussions, deliberations, information and records whether in written, electronic, and/or other formats, generated in connection with the care of patients.

I understand that by signing this agreement I am biding myself by contract to maintain such confidentiality. I agree that I will not make any voluntary disclosure of such confidental information except to persons authorized to receive it. This obligation of strictest confidence shall survive the termination of my employment or contact.

Printed Name:
Signed: Dated
Position of Title:

Ginger Fitness & Rehabilitation Physical Therapy For 0-100+
Agreement Regarding Use of Cell Phone while Driving

Using cell phones while driving is distracting and dangerous, including talking, dialing, text messaging, use of the internet, emails, etc. Ginger Fitness and Rehabilitation, Inc. does not require that employees use cell phones for any business and patient care purposes while driving.

Employees are responsible for his/her own action while using cell phones.

I , understand that I am informed of Ginger Fitness & Rehabilitation, Inc.'s policy on cell phone use while driving. I understand that I am under no obligation to use the cell phone while driving.

Signed: Date:

Ginger Fitness & Rehabilitation, Inc
Automobile Insurance Agreement

I hereby agree that I will carry automobile liability insurance as provided by current Florida Statutes.

I hereby agree to indemnify and hold harmless Ginger Fitness and Rehabilitation, Inc. from any claims arising out of the negligence of my motor vehicle

I further agree to inform Ginger Fitness and Rehabilitation, Inc immediately of any incident, accident which may occur while on business, cancellation of insurance policy and other pertinent facts pertaining to my automobile insurance

Upon request, I can provide a copy of my insurance face/declaration page showing effective dates and liability limits.

Employee name:
Employee signature: Date:

Ginger Fitness & Rehabilitation, Inc
27553 Cashford Circle, Suite 101
Wesley Chapel, Florida 33544
813-631-9700 fax: 813-631-9770

I have received or read a copy of the GFR Policy and Procedure Manual, specifying policies, practices, and regulations, which I agree to observe and follow during my employment with the company. I understand that it is my responsibility to be familiar with its contents and to ask questions on any matters I don't understand.

Employee Signature Date

Ginger Fitness & Rehabilitation
New Employee Checklist

For:
Date of hire:

Welcome to Ginger Fitness & Rehabilitation
Physical Therapy For 0-100+

	Introduce employee to co-workers, and review policy handbook
	Orient employee to clinic, and give tour: Bathrooms Photocopy machine Fax machine Supplies Linen closets All Modalities (ho₊, ice packs, US machine, TENS Unit) Cleaning list and supply location
	Review clinic policies and procedures: Timesheets Dress Code Hygiene Hours of Work Work Rules Attendance Policy Phone etiquette
	Review safety procedures: Proper use of gait belt Lifting techniques Location of first aid and emergency supplies BP Cuff
	Introduce Elite scheduling and program
	Summergate Clinic Westwood Clinic Temple Terrace Clinic Harc Pyramid McDonald Training Center

Employment Eligibility Verification

USCIS

START HERE.

ANTI-DISCRIMINATION NOTICE:

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Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

Form W-4 (2014)

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