Please list three professional references.

Compassionate Healthcare nursing services Inc., the agency I contract with, has provided me with education about the Hepatitis B vaccine. I understand the effectiveness of the vaccine, the risk of contracting Hepatitis B due to exposure to blood and other potentially infectious materials while working at the various sites that Compassionate Healthcare Nursing Services Inc. is currently under contract to service with staffing needs, and the importance of taking active steps to reduce the risk. I currently choose of my own free will, hereby DECLINE/CONSENT being given the Hepatitis B vaccine. I do understand that if I decline the vaccination at this time I may still receive it in the future.

Compassionate Healthcare Nursing Services Inc. (CHNS) desires to engage and contract for the services of the undersigned (Independent Contractor) to perform a certain task as set forth herein. Independent Contractors who desire to enter into this contract agreement and perform as a contractor of CHNS must be willing and able to perform the conditions set forth.

Equal Employment Opportunity Employer CHNS is committed to a policy of equal employment opportunity for all applicants and employees. Accredited prohibits discrimination against qualified applicants or employees because of race, color, religion, sex, gender identity, pregnancy, national origin, ancestry, citizenship, age, marital status, physical disability, mental disability, medical condition, genetic characteristics, sexual orientation, or any other characteristic protected by state or federal law, and any information furnished on this application will not be used for any purpose prohibited by law.

I Hereby certify that the information in this application is correct and complete to the best of my knowledge. I understand that falsification or omission of any material information on this application, in the interviewing process, or in my resume, or failure to pass a physical examination may be sufficient cause for immediate termination if I have already received an offer of employment. I understand that this application will no longer be active or receive further consideration once the position for which I am applying has been filled, or if I am employed but do not actively work for CHNS for a period of six months or more.

I agree to have any of the statements herein as well as my background investigated by CHNS or its agents. This authorization shall become effective immediately and shall remain in effect for a period of twelve months after the date of signing this authorization. I understand that the background investigation may include, but is not limited to, reviewing my education, employment history, public records, and personal references, whether through a search of my Social Security number, name, or other identifying information. In reviewing my employment history, I understand that CHNS may contact any or all of my listed previous employers, and I consent to CHNS doing so. In consideration for reviewing my application and other related information, I hereby waive and release CHNS, its employees and agents, and all other entities and persons from any claims I might have, including defamation and invasion of privacy, arising out of any verbal or written inquires and/or any verbal or written responses related to the investigation of my background as well as the use or disclosure of such information. I understand that a photocopy of this authorization is to be considered as valid as the original.

I agree that if employed, I will abide by all policies and procedures established by the Company. I acknowledge that the Company reserves the right to amend or modify any of its handbooks, policies, and procedures at any time and without prior notice. I understand that my employment is “at will”, that I may resign at any time, that the Company may terminate my employment at any time, with or without cause, and that no employee or other representative of the Company has the authority to make an agreement contrary to the foregoing unless it is in writing and signed by the Company President. This constitutes my entire agreement with the Company regarding the matters set forth in this paragraph.

Understand that Compassionate Healthcare Nursing Services Inc., is not an employment agency and that the services it renders are made possible only by a substantial investment in the hiring process for a large staff. As a condition of employment, I agree not to solicit any client or patient for employment that I am assigned, from this date and for a period of 270 days from the last date employed by Accredited. In the event this agreement is violated, I acknowledge it would be difficult to ascertain the precise number of damages that Compassionate Healthcare Nursing Services Inc. would suffer. Therefore, I agree that I will be obligated to pay CHNS $5000.00 in liquidated damages.

I agree to maintain the confidentiality of all patient information including, but not limited to, names and addresses of clients and referral sources, patient medical condition and course of treatment, rates, etc.; and I understand that my failure to do so may result in disciplinary action up to and including discharge. I also agree to follow the rules and regulations set forth by the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act) which helps ensure that all medical records, medical billing, and patient accounts, both printed and electronic, meet certain consistent standards regarding documentation, handling, and privacy. 

Recognizing that payroll errors may occur for a number of reasons (e.g. illegible timecards, misidentification of employee name or number, keystroke errors), if I am employed, and I authorize Accredited to withhold payment in order to correct any payroll error that may have resulted in my overpayment.

This agreement does not constitute a hiring by either party. It is the party's intention that Independent Contractor status and not be an employee for any purposes including without limitation, the application of the Federal Insurance Contribution Act, the Social Security Act, the provisions of the Internal Revenue code, all state rules and regulations relating to income tax withholding at the source of income, and all other benefits and third-party liability claims. This agreement shall not be liable for any obligations incurred by Independent Contractor unless specifically authorized in writing.

Upon termination of this Agreement, or whenever requested by Compassionate Healthcare Nursing Services Inc, Independent Contractor shall immediately deliver to Compassionate Healthcare Nursing Services Inc. any Confidential Material and all other property in Independent Contractor's possession, or under his/her care and control, belonging to Compassionate Healthcare Nursing Services Inc. Legal Compliance and Adherence to CHNS Policies and Procedures. Independent Contractor is required to treat all Compassionate Healthcare Nursing Services Inc. employees, patients, clients, business partners and other affiliates responsibly and with respect. Independent Contractor agrees to adhere to all Compassionate Healthcare Nursing Services Inc.' policies and procedures. Independent Contractor is required to comply with all laws governing his/her profession, licensing requirements and any other laws or regulations that are necessary in connection with Independent Contractor's provision of services hereunder. In accordance with the foregoing, Independent Contractor hereby agrees to (i) keep current his/her nursing or CAN license, CPR certification, and PPD or chest X-ray and (ii) refrain from providing more than sixteen (16) hours of service to any Compassionate Healthcare Nursing Services Inc. patient or client or to any other person(s) within a twenty-four (24) hour period. Failure to comply with the foregoing shall result in temporary or permanent removal from any and all current and/or future assignments, at the sole discretion of Compassionate Healthcare Nursing Services Inc. Malpractice Insurance. Independent Contractor is required to have and maintain malpractice insurance reasonably acceptable to Compassionate Healthcare Nursing Services. If Independent Contractor does not have such insurance prior to commencement of an assignment with Compassionate Healthcare Nursing Services, Independent Contractor hereby authorizes Compassionate Healthcare Nursing Services Inc. to submit the application attached hereto as Attachment A (completed and executed by Independent Contractor in connection with, and pursuement to, the terms of this Agreement) on behalf of Independent Contractor and obtain the corresponding malpractice insurance policy on Independent Contractor's behalf. Independent Contractor acknowledges and agrees that the cost of such policy shall be deducted from the initial payment to Independent Contractor for services rendered hereunder immediately following Compassionate Healthcare Nursing Services Inc. obtainment of such insurance policy on behalf of independent Contractor. Indemnification. Independent Contractor shall defend, indemnify and hold harmless Compassionate Healthcare Nursing Services Inc. from any and all damages, expenses or liability resulting from, or arising out of, any negligence or misconduct on the part of Independent Contractor, or from any breach or default of this Agreement which is caused or occasioned by the acts or omissions of Independent Contractor. Compensation. Independent Contractor shall be entitled to compensation for the services provided hereunder strictly for his/her hours worked at the rate of

Term and Termination. The term of this Agreement shall commence on the date this Agreement is executed by both parties as set forth below and shall remain in effect until Independent Contractor ceases (for any reason) to provide the services contemplated hereunder. Notwithstanding the foregoing, this Section 13 and Sections 2, 3, 4, 5, 6, 7, 8, 11, 14, 16, and 17 shall survive the termination or expiration of this Agreement. Attorneys' Fees. In the event any litigation, arbitration, mediation or other proceeding (collectively, "Proceeding") is initiated by any party against the other party to enforce, interpret or otherwise obtain judicial or quasi-judicial relief in connection with this Agreement, the prevailing party in such Proceeding shall be entitled to recover from the unsuccessful party all costs, expenses and actual attorneys' fees relating to or arising out of (i)such proceeding, whether or not such proceeding proceeds to judgement, and (ii) any post-judgement or post-award proceeding, including, without limitation, one to enforce any judgement or award resulting from any such Proceeding. Modification and Wavier. Any modification of this Agreement shall be effective only if it is in writing and executed by both parties. Any wavier of a default under this Agreement must be in writing and shall not be a waiver of any other default concerning the same or any other provision of this Agreement. No delay or omission in the exercise of any right or remedy shall impair such right or remedy or be construed as a waiver. A consent o9r approval of any act shall not be deemed to waive or render unnecessary consent to or approval of any other or subsequent act. Representation and Prior Understandings. Each party acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party hereto, or anyone acting on behalf of any party hereto, which are not embodied herein, and that no other agreement, statement or promise not contained in this Agreement between the parties with respect to the subject matter hereof, is intended as a final expression of the agreement of the parties with respect to the terms included in this Agreement, and supersedes all negotiations, stipulations, understandings, agreements, representation and warranties, if any, which precede or accompany the execution of this Agreement.

Miscellaneous Each party has reviewed and had the opportunity to revise this Agreement. Each party has had the opportunity to have legal counsel review this Agreement. The rule of construction that any ambiguities are to be resolved against the drafting party shall not be employed in the interpretation of this Agreement or of any amendments or exhibits to this Agreement. If any provision of this Agreement is held by a court of competent jurisdiction to be invalid, void or unenforceable, the remaining provisions shall nevertheless continue in full force and effect without being impaired or invalidated in any way. This Agreement is to be construed pursuant to the laws of the state of Maryland without reference to the conflicts of laws principles thereof. This Agreement may be executed in any number of identical counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. Independent Contractor hereby acknowledges that he/she has received a signed copy of this Agreement.

I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE THE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND THAT IF EMPLOYEED, ANY FALSEIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR TERMINATION.

I AUTHORIZE AN INVESTIGATION OF ALL THE STATEMENTS OBTAINED HEREIN AND THE REFERENCE LIST ABOVE

Executives employment with the Company is "at-will." This means Executive may resign at any time for any reason. Likewise, the Company may terminate Executives employment with the Company at any time and for any reason, without notice. Any change to the at-will employment relationship must made be by a specific, written agreement signed by Executive and the Company's Compensation Committee. The Employee shall not be required to mitigate damages or the amount of any payment provided under this Agreement by obtaining other employment or otherwise after the termination of employment hereunder, and any amounts earned by the Employee, whether from self- employment or other employment shall not reduce the amount of any Severance Pay or CIC Severance Pay, as the case may be, called for Initial herein