Saunified Homecare

For caregivers

Caregiver forms

Tax, eligibility, certification, and onboarding forms. Federal and NY State forms link to the authoritative source so you always get the current version.

Have a question? Apply or ask in the application →

Before your first shift

Every caregiver meets these before stepping into a client's home.

Before you apply

Optional prep — fill these out ahead of your in-person visit to save time.

  • New Applicant Physical Form

    Medical

    Before your hire date, S&A Unified Home Care requires a completed pre-employment health assessment. The exam cannot be dated more than 12 months before you are hired.

    PDF · S&A Unified Home Care

    View form

Active caregivers

Annual re-submissions, tax updates, and certification renewals.

  • W-4 (Federal tax withholding)

    Tax

    Required so we withhold the right amount of federal income tax from your paychecks. Bring this completed to your in-person visit.

    PDF · IRS

    View form
  • Declination of Influenza Vaccination

    Medical

    A signed acknowledgment for healthcare personnel who choose not to receive the annual flu vaccine.

    PDF · S&A Unified Home Care

    View form
  • IT-2104 (NY State tax withholding)

    Tax

    New York State equivalent of the federal W-4. Required for NY-based caregivers.

    PDF · NY State

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  • Annual Physical Form for Existing Caregivers

    Health

    NY DOH requires every home-care caregiver to submit an annual physical, TB test, and drug test. Print this form, have your physician complete and sign it, then submit to your local office before your renewal date.

    PDF · S&A Unified Home Care

    View form
  • Address Change Form

    Update

    Submit this whenever your home address changes — moving boroughs, moving across town, or any update to where we should send mail, paystubs, and tax documents. Mail or fax the completed form to your local office.

    PDF · S&A Unified Home Care

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  • Wage Breakdown

    Payroll

    Detailed breakdown of pay rates and wage-parity benefits for the 2026 calendar year. Required under NY Wage Parity for transparency — reference this when reconciling a paystub.

    PDF · S&A Unified Home Care

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  • Rate Change Notice

    Payroll

    Notification of pay rate changes. Review this whenever your hourly rate, language differential, or shift premium is updated so you know what to expect on your next paystub.

    PDF · S&A Unified Home Care

    View form

Ready to start?

Speak with our care team today — most callers are matched with a caregiver within a week.

Know someone who needs care? Share our number — our intake team handles referrals right on the call.

Find your nearest office

Six neighborhoods across NYC and Long Island.

Find your nearest office →
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