01.14: Forms to complete

Important! 
  • Do not wait until your forms are due to read the instructions below. 
  • Several forms are extensive and require time and planning to complete. 
  • A few require either witnesses or notarization. 
Please read the following instructions carefully, and review the applicable forms which are included either as downloads or web links. These forms are due back to EMM on the date provided to you by HR. If you do not know when your forms are due, please ask Cara Kilheffer (cara.kilheffer@emm.org or 717-898-2251 ext 247). 

Unless noted otherwise, forms should be mailed to Cara Kilheffer, Human Resources, Eastern Mennonite Missions, PO Box 458, Salunga, PA 17538 by the date provided.

Pre-training forms
If you have not done so already, carefully read about EMM's medical coverage policy and then complete the appropriate medical form for your length of assignment: 
 
 
Return your completed medical form to EMM. 

Publicity card forms are a great way to spread the news of your mission assignment and remind people to pray for you! They are an attractive addition to support raising letters. Please follow the link above to complete the publicity card form online. The sooner you complete the form and submit the information, the sooner you will receive your cards. Once ordered, it may take six weeks until you receive your cards. Remember to follow the guidelines included on the online form for submitting or arranging a photo of yourself. 

With a general power of attorney form, you designate someone to take care of financial matters on your behalf. During your assignment, EMM may choose to channel funds for you through the person you designate. This person may also file taxes on your behalf if you are out of the country during that time of year. It is important to select someone you trust who has agreed to be responsible for your finances -- and income taxes, if applicable -- while you are on assignment overseas. 

If serving overseas for two months or longer, you are required to have a notarized general power of attorney statement, with a copy on file at EMM's central administrative office (workers under 18 years of age are exempt). 

If you are from Pennsylvania, you may use the form at the link above to designate your POA agent. Another option is to draft your own letter. If drafting your own letter, make sure the document includes Principal Notice, General Power of Attorney, and Agent Acknowledgement components. 

If you are from a state other than Pennsylvania, you may visit this website http://powerofattorney.com/ to find a form appropriate for your state. Please also check your state’s requirements for POA documents to be sure your form complies with the law. Your POA document must be notarized. Give one copy to your POA agent and one copy to EMM. You may keep the original notarized document for yourself. 

PLEASE NOTE: Yourself, the person you designate as POA agent, and two other adult witnesses must be present to sign at the time of notarization. You may pay for a public notary or you may contact EMM to have your document notarized at our office free of charge. Please contact Cara Kilheffer at carak@emm.org to set up an appointment. 

In the event of a crisis, medical directives may help to provide clarity when difficult decisions need to be made about your care. You are required to complete a Healthcare Power of Attorney and a Living Will in the event you are seriously injured during your assignment (workers under 18 years of age are exempt). Please follow the link below to CaringInfo where you can download a form applicable for your state: http://www.caringinfo.org/stateaddownload 

Give copies of your complete medical directives to the person you select to make medical decisions on your behalf, and others who may need to make emergency decisions about your care. Please also give a copy of your medical directives to EMM.

PLEASE NOTE: Medical directive documents usually require signatures from yourself and two adult witnesses. See form for more details about selecting witnesses. 

You are eligible for worker's compensation if you are injured during your assignment while in the United States. Please sign this form and return it to EMM. Signing indicates that you acknowledge your rights and responsibilities while in the United States during your EMM assignment. Your training in the US is considered a part of your assignment IF it occurs within two weeks of your departure for the field. (Departure dates must be finalized before training in order for this inclusion to apply.) Worker’s compensation does not apply during your time overseas. If your entire assignment is in the United States, worker's compensation applies for the entirety of your assignment. 

Each EMM missionary over the age of 18 is asked to sign the attached Covenant of Understanding. We also ask that you inform us of your burial preferences in the event of death while traveling or on outreach. Please return a copy to EMM.

This form gives EMM permission to share your medical insurance and history form and your medical directives with your immediate supervisor on the field. 
Please follow the link above to download and sign this form. Return to EMM. 

You will receive a customized ministry agreement similar to this sample before or after your training. You will be asked to affirm the agreement through email or with your signature. The agreement will also be affirmed by your MST leader, your outreach coordinator, and EMM’s personnel placement coach and regional representative.

Tax forms 

Since you will be receiving taxable income from EMM during your assignment, please complete the applicable forms (see instructions below) and return the originals (the documents that you actually signed) to EMM. No copies are accepted.

Pennsylvania residents
Please complete the residency certification and local services tax forms. If you are serving less than 330 days outside the U.S., you must also complete the W4 form. If you are serving 330 days or more outside the U.S., you may complete either the W4 or the 673 exemption form. The 673 form must be completed for each calendar year that you will be on assignment.

Non-Pennsylvania residents
Please complete the residency certification and local services tax forms. Although you do not reside in Pennsylvania, you need to complete the residency certification and the local services tax forms because your employer (EMM) is located in Pennsylvania. 

If you are serving less than 330 days outside the U.S., you must also complete the W4 form. If you are serving 330 days or more outside the U.S., you can complete either the W4 or 673 exemption form. The 673 form must be completed for each calendar year that you will be on assignment.
 
Forms to complete during training
You will be asked to sign this form following the policy session of your training. Please note that this form requires you to print and sign your name four times.

This is a legal identification document which will need to be completed with an EMM staff member on the first day of your training. You will need to have with you acceptable identification document(s). Acceptable documents include 
  • your passport, or 
  • your driver’s license AND social security card
For more information, please see I-9 form