Form FIA-1100 "Work Schedule for Child Care" - New York City (Haitian Creole)

This is a legal form that was released by the New York City Department of Social Services - a government authority operating within New York City.

The document is provided in Haitian Creole. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 17, 2017;
  • The latest edition provided by the New York City Department of Social Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form FIA-1100 by clicking the link below or browse more documents and templates provided by the New York City Department of Social Services.

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Download Form FIA-1100 "Work Schedule for Child Care" - New York City (Haitian Creole)

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FIA-1100 (D) 01/17/2017 (page 1 of 2)
(E) 12/27/2016
LLF
Orè Travay Sèvis Pou Gadri (Haitian Creole)
Ou dwe ranpli fòm sa a pou resevwa sèvis gadri. Fòm sa a poze kesyon sou patwon ou
ak jou ak lè ou travay. Si jou ak lè ou travay yo chanje, bay jou ak lèt ou travay pi souvan.
Non Moun ki Aplike a/Patisipan an:
Nimewo Dosye Èd Lajan Kach:
Non Patwon an:
Adrès Patwon an:
Adrès Travay si li Diferan avèk Adrès Patwon an:
Si adrès travay la se nan Vil New York, reponn kesyon ki anba la yo dapre tout sa ou konnen.
Patwon an gen yon total
11 oswa plis anplwaye
10 oswa mwens anplwaye
Orè chak Semèn
Jou yo
Lendi
Madi
Mèkredi
Jedi
Vandredi Samdi Dimanch
Lè pou
Kòmanse:
Kantite
èdtan
total ou
pou Fini:
travay pa
semèn:
Kantite
èdtan ou
te travay:
Kantite Tan ou Vwayaje pa Semèn: Si lè pou vwayaje a pa menm chak jou, itilize tan ki pi
long ou vwayaje a epi miltipliye li pa senk (5). Pa egzanp: De (2) jou pa semèn ou vwayaje
miltipliye pa de (2) èdtan, epi twa (3) jou pa semèn kantite tan ou vwayaje se yon (1) èdtan,
kantite tan total vwayaj ou ta dwe 5x2 = 10 Èdtan.
Total pa Semèn Tan Vwayaj:
FIA-1100 (D) 01/17/2017 (page 1 of 2)
(E) 12/27/2016
LLF
Orè Travay Sèvis Pou Gadri (Haitian Creole)
Ou dwe ranpli fòm sa a pou resevwa sèvis gadri. Fòm sa a poze kesyon sou patwon ou
ak jou ak lè ou travay. Si jou ak lè ou travay yo chanje, bay jou ak lèt ou travay pi souvan.
Non Moun ki Aplike a/Patisipan an:
Nimewo Dosye Èd Lajan Kach:
Non Patwon an:
Adrès Patwon an:
Adrès Travay si li Diferan avèk Adrès Patwon an:
Si adrès travay la se nan Vil New York, reponn kesyon ki anba la yo dapre tout sa ou konnen.
Patwon an gen yon total
11 oswa plis anplwaye
10 oswa mwens anplwaye
Orè chak Semèn
Jou yo
Lendi
Madi
Mèkredi
Jedi
Vandredi Samdi Dimanch
Lè pou
Kòmanse:
Kantite
èdtan
total ou
pou Fini:
travay pa
semèn:
Kantite
èdtan ou
te travay:
Kantite Tan ou Vwayaje pa Semèn: Si lè pou vwayaje a pa menm chak jou, itilize tan ki pi
long ou vwayaje a epi miltipliye li pa senk (5). Pa egzanp: De (2) jou pa semèn ou vwayaje
miltipliye pa de (2) èdtan, epi twa (3) jou pa semèn kantite tan ou vwayaje se yon (1) èdtan,
kantite tan total vwayaj ou ta dwe 5x2 = 10 Èdtan.
Total pa Semèn Tan Vwayaj:
FIA-1100 (D) 01/17/2017 (page 2 of 2)
Human Resources Administration
(E) 12/27/2016
Family Independence Administration
LLF
Orè Travay Pou Lòt Adilt ki nan Kay la
Relasyon avèk Timoun:
Paran
Responsab Legal
Non Moun ki Aplike a/Patisipan an:
Nimewo Dosye Èd Lajan Kach:
Non Patwon an:
Adrès Patwon an:
Adrès Travay si li Diferan avèk Adrès Patwon an:
Si adrès travay la se nan Vil New York, reponn kesyon ki anba la yo dapre tout sa ou
konnen.
Patwon an gen yon total
11 oswa plis anplwaye
10 oswa mwens anplwaye
Orè chak Semèn
Jou yo
Lendi
Madi
Mèkredi
Jedi
Vandredi Samdi Dimanch
Lè pou
Kòmanse:
Kantite
èdtan
total ou
pou Fini:
travay pa
semèn:
Kantite
èdtan ou
te travay:
Kantite Tan ou Vwayaje pa Semèn: Si ta pou vwayaje a pa menm chak jou, itilize tan ki pi
long ou vwayaje a epi miltipliye li pa senk (5). Pa egzanp: De (2) jou pa semèn ou vwayaje
miltipliye pa de (2) èdtan, epi twa (3) jou pa semèn kantite tan ou vwayaje se yon (1) èdtan,
kantite tan total vwayaj ou ta dwe 5x2 = 10 Èdtan.
Total pa Semèn Tan Vwayaj:
Mwen sèmante oswa mwen konfime enfòmasyon ki nan fòm sa a se enfòmasyon ki vrè ak
kòrèk.
Non Moun ki Aplike/
Siyati Patisipan an: _______________________________ Dat la: _______________
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