Self-Direction Forms

Self-Direction Application

Please download and complete the Employment Packet, Pre-Employment Physical Examination, Background check form, IRS W-4 form, IRS W-9 form as well as the Federal I-9 form, which verifies Employment Eligibility. Please email the completed forms to selfdirection@halonetworkinc.com or Fax to (631) 789-7383.

Upon receipt and revision of the application, we will contact you to schedule your fingerprinting appointment. The Justice Center sends the result of the background check to Halo Network, Inc. At that time, we will schedule an appointment for you to bring your Employment eligibility ID to one of our 2 offices on Long Island.

Important: In addition to submitting these forms, please email the original copies to:
221 Broadway, Suite 206 Amityville, NY 11701

Employment Packet

Download

Pre-Employment Physical Examination

Download

Background Check Form

Download

IRS W-4 Form

Download

Federal I-9 Form
(Please provide identification along with form. Also please do not date form.)

Download