Forms

Necessary forms for both self-directed (FMS) and agency-directed services
Below you can find the necessary forms for both Financial Management Services (FMS) and Agency-Directed forms. 
Applying to work for a self-direct client, please complete the following application.

FMS Employee Application

Wanting to apply to the ASHC Agency?
Please complete the following application.

Agency Employment Application

FMS, Self-direct worker State Tax form

K-4 FMS State Tax Form

Agency State Tax form

K-4 Agency State Tax Form

FMS, Self-direct worker Worker Federal Tax form

W-4 FMS Federal Tax Form

Agency Federal Tax form

W-4 Federal Tax Form

FMS Client Open - Self Direct Client Paperwork

Client Open - FMS

Fill out completely and submit a check or print out from the bank that has the routing and account number typed.

Direct Deposit Form

FMS Self-direct clients need to fill out to determine the pay rate the worker will make prior to claiming time worked.

Pay Assignment Form

Complete form to change personal information. If documents are required for a name change, please submit with completed form.

Information Change Request

Employment agreement that must be filled out by self-direct client and worker being hired prior to claiming time worked

ESA - Employment Agreement

ASHC Agency requires background checks prior to employment. Please complete the following form.

Background Check Forms

All Saints Home Care 
3425 W. Central Ave. 
Wichita, KS 67203
Office | 316.755.1076
Fax | 316.755.9076
All Saints Home Care is an equal opportunity employer. All Saints Home Care prohibits discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion, sex, national origin, age, disability or genetic information.

COVID-19 INFORMATION

Like many of you, we at All Saints Home Care have spent the last several weeks educating ourselves about the Coronavirus (COVID-19). As the Coronavirus and its impact continue to evolve and develop, All Saints remains focused on the health and safety of our customers, employees and communities.

During this time, we are closely following the Centers for Disease Control's (CDC) guidelines and recommendations on the steps we can take to help prevent the spread of the virus.

Effective immediately, we have implemented the following precautionary changes to our work and office operations, to decrease the risk of exposure. It is important that you are aware of these changes to avoid unnecessary travel and frustration when coming to the office.

  • Until further notice, our office staff will not be available to speak with you in person; however, all staff may be reached by phone or email.
  • All forms, including applications and timesheets, will be available in the front entryway, on the wall. All forms can also be downloaded from www.allsaintshomecare.com/forms.
  • All completed paperwork can be mailed, faxed, put in after hour drop box next to the front door, or placed in the basket located in our front entryway.
  • Picking up your check will no longer be an option. Checks will be either direct deposited or mailed. Payroll cards will be available soon.


We will continue to closely monitor the situation as it changes and do all we can to protect you, our loyal customers and compassionate employees. Through these uncertain times, you can rest assured that regardless of what measures are required of us, our commitment is to continue to hold your well-being as our number one priority.

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