GALAXY HOME CARE LLC

Confidential Reference Request and Verification -1-

I, (Name of applicant) Care LLC for employment and have had a face-to-face interview with a Galaxy Home Care representative. I

hereby release from all liability the company and/or person completing this form and authorize them to release all information regarding my employment with them.

Galaxy Home Care conducts a complete reference check, prior to hiring, on each applicant for employment. All information you supply is confidential. Any statements you wish to make that would help us determine a placement for this applicant may be entered in the space provided for "Comments" or you may call the office for a confidential conversation. We appreciate your prompt reply.

Is the above information, correct?

Please rate the applicant using the following guidelines: Above average Attendance/Dependability Quality of Work Follows Directions Cooperation/Attitude

101 Coventry CircleLansdale, PA 19446Fax: (215) 365-0733 Phone (215) 588-5068

Confidential Reference Request and Verification -2-

I, (Name of applicant) Care LLC for employment and have had a face-to-face interview with a Galaxy Home Care representative. I hereby release from all liability the company and/or person completing this form and authorize them to release all information regarding my employment with them.

Galaxy Home Care conducts a complete reference check, prior to hiring, on each applicant for employment. All information you supply is confidential. Any statements you wish to make that would help us determine a placement for this applicant may be entered in the space provided for "Comments" or you may call the office for a confidential conversation. We appreciate your prompt reply.

Is the above information, correct?

Please rate the applicant using the following guidelines: Above average Attendance/Dependability Quality of Work Follows Directions Cooperation/Attitude

101 Coventry CircleLansdale, PA 19446Phone (215) 588-5068Fax: (215) 365-0733

Employee Background Check - Employer Decision

If the State Police criminal history record, the federal criminal history record or the Department of Aging letter of determination reveals a criminal record or conviction, Galaxy Home Care may consult with an attorney prior to making an employment decision to ensure compliance with the Commonwealth Court's guidance regarding exercising hiring discretion on a case-by-case basis. This guidance focuses on the consideration of factors such as the:

Facts surrounding the conviction Time elapsed since conviction Evidence of individual's rehabilitation Nature and requirements of the job Performance of individualized risk assessments relative to the care and services to be provided to the client

Based on consideration of the factors listed above, Galaxy Home Care leadership team has decided to employ the individual listed below under the following guidelines: Employee will only work with a family member or a client requesting them, specifically.

Galaxy Home Care will make additional quality management calls to the clients the employee is working with during the first 90 days of employment to ensure client satisfaction.

Employee can work without restrictions or additional oversight.

LansdalePA 19446-6400Phone: +1 (215) 588-5068Fax: +1 (215) 565-0733 101 Coventry Cir Email: info@galaxyhomecarellc.com

Tuberculosis (TB) Risk Assessment Questionnaire

1. Are you from or have you lived for two months or more in Africa, Asia, Central or South America, or Eastern Europe?Yes No If yes, list countries

2. Have you been diagnosed with a chronic condition that may impair your immune system? YesNo If yes, check all that apply

Chronic steroid use HIV infection Cancer of the head or neck Silicosis Leukemia, lymphoma or Hodgkin's disease

Gastrectomy/intestinal bypass Crohn's disease Rheumatoid arthritis Use of a TNF- a antagonist Other:

Diabetes mellitus Dialysis/Renal failure Chronic malabsorption syndromes Low body weight (10%+ below ideal)

3. Have you ever resided, worked or volunteered in any of the following facilities? YesNo If yes, check all that apply

Hospital Other long term treatment center:

4. Do you currently have any of the following symptoms?

No If yes, check all that apply

Cough ≥ 3 weeks Productive cough Coughing up blood

Unexplained fever Night sweats Unexplained weight loss

Chest pain Respiratory difficulty Fatigue

Chills Loss of appetite Weakness

5. Have you ever had contact with a person known to have active tuberculosis?YesNo

6. Have you ever used injection drugs?YesNo

7. When was your last tuberculin skin test or chest x-ray to rule out TB? (attach results)

The information above is true and complete to the best of my knowledge, and I am aware that deliberate misrepresentation may jeopardize my health. I understand that this information is confidential and will not be released without my knowledge and written permission.

All information below is to be completed by an approved screener

Findings (Check all that apply)

Previous Treatment for TB disease Possible TB suspect

No risk factors for TB infection Risk(s) for infection and/or progression to disease

Previous positive TST, no prior treatment

Actions (Check all that apply)

Issued screening letter Issued Sputum containers

Referred for CXR Administered Mantoux TB Test

Referred for medical evaluation Other:

Have you had, or do you have any of the following conditions:

Arthritis Asthma Back Trouble Convulsions Diabetes

Difficulty Seeing Fainting/Dizzy Spells

Mental Illness Rheumatic Fever Severe Headaches Stomach Ulcers Venereal Disease

Are you now taking medications prescribed by a physician? If yes, which medications:

Have you ever had an illness caused by any type of work? If yes, which explain:

I certify that the above answers are true to the best of my knowledge. I understand that this assessment is for employment purpose, not for diagnosis/treatment. Nor does it replace my physical examination.

I. Organization Overview B. Patient Population and Geographic Area Served C. Regulations Governing the Delivery of Home Care Services D. Agency Philosophy of Patient Care E. Organizational Structure/Role of Team Members: a. Managing Member b. Administrator C. Personal Care Aide d. Homemaker e. Companion F. Quality Management G. Distribution of Employee Handbook and Job Description H. Storage, Handling and Access to Supplies I. Orientation Checklist

A. Overview to Care and Services

II. Communication Skills A. Overview to the Communication Process B. Effective Communication Techniques C. The Skill of Listening D. The Aide/Personal Care Assistant's Role in Communication E. Factors that May Affect the Client's Ability to Communicate F. Dealing with Difficult Behaviors G. Cultural Diversity and Sensitivity H. HIPAA and Confidentiality Guidelines I. Communication Exercise

III. Overview to Home Care Patient and Rights & Responsibilities A. Physical, Emotional and Developmental Needs of Clients B. Changes Occurring as a Result of the Aging Process C. What Can You Do To Promote the Client's Comfort? D. The Concept of Respect and Dignity E. Patient Rights and Responsibilities F. Client Control and the Independent Living Philosophy IV. Infection Control and Safety A. Basic Infection Control B. Standard Precautions C. Personal Protective Equipment D. Guidelines for Handwashing E. Disposing of Contaminated Supplies F. Cleaning a Spill of Potentially Infectious Waste G. Overview to Safety in the Home Environment H. Body Mechanics I. Falls Prevention and Falls Assessment J. Safety Tips and Checklist, Accident Prevention K. Fire Safety

101 Coventry CirLansdalePA 19446-6400 Phone: +1 (215) 588-5068Fax: +1 (215) 565-0733 Email: info@galaxyhomecarellc.com

V.Homemaking/Maintenance of a Clean, Safe and Healthy Environment A. Maintaining a Clean, Safe and Healthy Home Environment B. Changing Bed Linens C. Laundry Care for Linens and Clothing D. Bathroom Cleaning E. Kitchen Cleaning F. Dusting and Vacuuming Emergency Procedures A. Recognizing Emergencies and Guidelines for Responding to an Emergency B. Home and Community Emergencies C. Calling 911 Emergency Medical Service D. Basic Symptoms of an Impending Heart Attack E. Heimlich Maneuver with Victim Standing or Sitting F. Heimlich Maneuver with Victim Lying Down G. Finger Sweep H. Symptoms of a Stroke (CVA) VII. Observation, Reporting and Documentation A. Recognizing and Reporting Abuse or Neglect B. Overview to the Care Delivery Process C. Observations, Reporting Changes and Reporting to Supervisor D. Overview to Documentation E. Patient Care Assignments and Use of the Service F. Following the Plan of Care G. Use of the Weekly Visit Record H. Reporting, Responding and Incidents

This employee has received orientation from me and other members of the management and home care team in all areas listed above related to the care, services, policies, procedures and operations of Galaxy Home Care.

I have received instructions in the subjects listed above, understand and will comply with the policies set forth in Galaxy Home Care's General Orientation Manual and the agency's Policy and Procedure Manuals.

LansdalePA 19446-6400Phone: +1 (215) 588-5068Fax: +1 (215) 565-0733 101 Coventry Cir Email: info@galaxyhomecarellc.com

ALAXYGalaxy Home Care LLC Conflict of Interest Disclosure Form

A conflict of interest is defined as making use of any knowledge or information acquired through working for Galaxy Home Care with clients, customers or in the conduct of Agency business, to your own advantage or profit. On an annual basis, all contractors and employees are asked to declare any potential conflicts of interest and forward these to the Administrator who acts on behalf of the agency and the Managing Member. As an employee or contractor of Galaxy Home Care, I agree to: 1. Act in the course of my duties solely in the best interests of Galaxy Home Care without consideration to the interests of any other agency, organization or business with which I am associated; and to refrain from taking part in any transaction where I do not believe in good faith that I can act with undivided loyalty to the agency. 2. Disclose any material, financial or other beneficial interest to any entity engaged in the delivery of goods or services to the agency or its members. 3. Disclose any transactions with the agency which would result in any benefit to me, my immediate family, or any entity in which I hold a significant financial ownership or other interests, and refrain from participation in any action on such matters except upon approval of the Managing Member after full and frank disclosure. 4. Refrain from utilizing any information relative to the business plans and activities of the agency for the benefit of myself, my immediate family or any entity with which I may be associated. In the event that a situation arises whereby agency personnel or contractors could use confidential or privileged agency information for personal gain, I understand | am obligated to report that potential to the Administrator as outlined above, with this potential conflict and the Administrator's decision regarding the actions noted in a log file kept by the Managing Member. The following is (are) my potential conflict of interest(s): (if none exists-write "NONE") Any "divided loyalty situations" where other full or part-time employment situations might lead to potential conflicts of interest: (For example, other agencies where you provide contract services)

Confidentiality Agreement/HIPAA Compliance

Galaxy Home Care maintains the confidentiality of protected health information as defined by HIPAA, as well as any other information that is deemed to be confidential by other laws. This information may include, but is not limited to, information on clients, employees, and financial and business operations. Confidential information may be information in any form including written, electronic, oral, overheard or observed. Employees or contractors may be exposed to

information that is considered to be confidential. This information should not be discussed with

anyone, including clients, client families, co-workers, or an employee's or contractor's family or friends. (Additional information regarding specifics of the confidentiality of client records can be found in the Policy and Procedure Manual All employees and contractors of Galaxy Home Care must be alert to others overhearing professional discussions regarding clients/families or personnel information, or any other confidential situations. Disclosure of confidential information is grounds for disciplinary action up to and including termination. All clinicians and employees must read and sign the Notice of Privacy Practice information provided.

Your Satisfaction is our Goal.

LansdalePA 19446-6400Phone: +1 (215) 588-5068Fax: +1 (215) 565-0733 101 Coventry Cir Email: info@galaxyhomecarellc.com

ALAXYGalaxy Home Care LLC Provisional Hiring Affirmation/Disclosure In accordance with $611.54 of the Home Care Agency licensing regulations, you may be hired on a provisional basis pending receipt of a criminal history report if the following conditions are met.

false alteration of, any record or document.

consumer feedback, and results will be documented in my file.

serve a provisional period of more than 30 days; and if I have NOT been a resident of Pennsylvania for 2 years or more, I cannot serve a provisional period of more than 90 days. Any prior convictions to the best of your ability/knowledge:

Iattest that the above information is true to the best of my knowledge and swear and affirm that

I have not been named or convicted of any crime that has not been disclosed and if I am so named or convicted at any time during my employment, I will advise my employer, Galaxy Home Care, of that fact. I understand that my employment may be terminated if I have been named or convicted of any crimes so as described prior to employment or at any time during my employment.

Galaxy Home Care RepresentativeTitle LansdalePA 19446-6400Phone: +1 (215) 588-5068Fax: +1 (215) 565-0733 101 Coventry Cir Email: info@galaxyhomecarellc.com

My signature on this form acknowledges that I have received a copy of the Galaxy Home Care Employee Handbook dated January 1, 2022. I understand that it is my responsibility to read the Handbook. If I have questions concerning the information herein, I will bring them to the attention of the Administrator.

I understand that the policies and procedures contained in the Handbook constitute guidelines only and are in no way to be interpreted as a contract between Galaxy Home Care and any of its employees.I further understand that Galaxy Home Care has the right to change, modify, or delete any of its work rules and policies at any time.

Your Satisfaction is our Goal.

LansdalePhone: +1 (215) 588-5068Fax: +1 (215) 565-0733 101 Coventry CirPA 19446-6400 Email: info@galaxyhomecarellc.com

Your Satisfaction is our Goal.

II. TUBERCULOSIS SKIN TEST RESULTS (Testing required per Regulations of the Department of Health) Tuberculosis/PPD Test (if required)

Alternative PPD Assessment (if required) X-Ray

QuantiFERON Gold Test (if required)

II. IMMUNIZATION HISTORY (Recommended, but not mandated by law)

Alcohol Diabetes Mellitus Gastrointestinal Disorder

Orthopedic Condition Respiratory Illness

Seizure Disorder Skin Disorder Vision Disorder

Height (inches) Weight (pounds) Pulse

Eyes - Visual Acuity: RL Eyes - Color Vision Ears - Hearing (dB) RL

Teeth and Gingiva Lymph Glands Heart - Murmur, etc. Lungs - Adventious Findings

Genitourinary Neuromuscular System

The statements and answers as recorded above are full, complete and true to the best of my knowledge and belief. I understand that any false or misleading statements may cause termination of my employment. I authorize the physician or other person to disclose any knowledge or information pertaining to my health to the employing authority for whom this examination is performed.

I understand that due to my occupational exposure to blood or other potentially infectious materials that I may be at risk of being infected by bloodborne pathogens, including Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV This is to certify that I have been informed about the symptoms and the hazards associated with these viruses, as well as the modes of transmission of bloodborne pathogens. I have been given the opportunity to be vaccinated with Hepatitis B vaccine. In addition, I have received information regarding the Hepatitis B (HBV) vaccine. Based on the training I received, I am making an informed decision to accept the Hepatitis B (HBV) vaccine.

I understand that due to my occupational exposure to blood or other potentially infectious materials that I may be at risk of acquiring Hepatitis B Virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine. However, I decline Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can do so at any time.

OSHA's Bloodborne Pathogens Standard 29 CFR 1910.1030

I ACCEPT Hepatitis B vaccine inoculation: OR I DECLINE Hepatitis B vaccine inoculation.

LansdalePA 19446-6400Phone: +1 (215) 588-5068Fax: +1 (215) 565-0733 101 Coventry Cir Email: info@galaxyhomecarellc.com

Congratulations! We welcome you to Galaxy Home Care Agency for a brighter future. Based on our prior conversation I am happy to inform you that the following wage has been approved effective datefor up tohours per week.

Your role in accomplishing our mission to provide the best care possible to our clients is greatly valued and of importance. Feel free to reach out with questions you may have about your new responsibilities/tasks. Ask your supervisor if you have any questions. We look forward to a better future as well as your continued success at Galaxy Home Care Agency.

Please Note: All overtime hours or hours above

HAVE TO BE reported and approved

by your manager before the hours are worked.

We also require HR Documentation and In-Services training to be completed. If you are unable to submit the above requirements, "Training-Compliance (If applicable)" will not apply. Until the required documentation is fulfilled, under no circumstances may employees begin work otherwise. You may refer to our "Employment Book" for any other payroll related policies.

Regular per Hour Overtime per Hour

As recognition, please sign below.

Sincerely, Mosammat Parvin, Supervisor For, Galaxy Home Care Agency

LansdalePhone: +1 (215) 588-5068Fax: +1 (215) 565-0733 101 Coventry CirPA 19446-6400 Email: info@galaxyhomecarellc.com

GALAXY HOME CARE LLC HANDBOOK ACKNOWLEDGEMENT

I acknowledge that I have received the GALAXY HOME CARE LLC (the "Company") Employee Handbook (the "Handbook") and have read and understand the terms and conditions discussed in the Handbook. I have had the opportunity to ask questions about the policies contained in the Handbook. As a condition of my employment with the Company, I agree to comply with all the rules and procedures of the Company, as stated in this Handbook, and any other policy that may be issued to me during my employment. I understand that the Company has the maximum discretion permitted by law to interpret, administer, change, modify or delete the rules, policies, and procedures contained in the Handbook at any time. I will be notified of any changes to the Handbook by the Company and my continued employment with the Company after receiving notice of any changes to the Handbook policies will be deemed consent and agreement to comply with the new or revised Handbook policies.

I expressly acknowledge that I have read the Fact-finding and Issue Resolution ("FAIR") Program terms and conditions, which requires me to submit any employment-related Claims to binding arbitration, and that I have to pursue such arbitration on an individual basis. I understand that the FAIR Program constitutes a binding agreement between the Company and me to individually arbitrate any claim. Any changes to the FAIR Program will be issued to me in writing and, before being bound to any such changes in the FAIR Program, I will execute a written agreement evidencing my consent to the changes in the FAIR Program.

I understand that nothing in this Handbook alters the at-will nature of my employment, as stated in this Handbook.

I understand and acknowledge that I may be terminated for violating any rules or procedures in this Handbook.

Galaxy Home Care: Employee Handbook