A Service of B1 Healthcare Solutions
Main Office: 1910 Lakeland Dr., Ste. C, Jackson, MS 39216
Satellite Office: 3100 Cottage Hill Rd., Building 5, Office 115, Mobile, AL 36606
Phone: 769-572-7207 Fax: 601-510-4844

Thank you for your interest in joining B1 Nursing Care. We are honored to serve our clients and their families, and we are looking for compassionate, dependable team members who share that commitment. Please complete every section of this packet fully and honestly. Incomplete applications may delay consideration.

• This completed application packet (all pages), signed and dated.
• A current resume, if available.
• Copy of a valid government-issued photo ID. Social Security Card
• Copies of any certifications or licenses relevant to the position (e.g., CNA, CPR/First Aid), if applicable.

B1 Nursing Care is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, genetic information, or any other status protected by law. Employment is at-will and contingent upon successful completion of background screening and pre-employment drug and alcohol testing.

List your most recent employers first. Include any caregiving or healthcare experience.

Employer 1

Employer 2

Employer 3

Please list at least two professional references who are not relatives.

A "yes" answer will not necessarily disqualify you from employment; each situation is considered individually and in accordance with applicable law.

Please read each statement carefully and sign below. Your signature indicates your understanding and agreement.

Certification of Accuracy.
I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any false statement, omission, or misrepresentation may disqualify me from consideration or, if discovered after hire, result in termination of employment.

Background Check Authorization.
I authorize B1 Nursing Care to verify the information in this application, including contacting my references and former employers, and to conduct a criminal background check and any screening required for the position for which I am applying.

Drug & Alcohol Testing Consent.
I understand that B1 Nursing Care maintains a drug-free workplace and that employment is contingent upon successfully passing pre-employment drug and alcohol testing. I consent to such testing in accordance with company policy.

At-Will Employment.
I understand that, if hired, my employment is at-will, meaning that either I or B1 Nursing Care may end the employment relationship at any time, with or without cause or notice. I understand that this application is not a contract of employment.

Transporting clients is not a required job duty and is generally not permitted. Employees may transport a client only with prior written authorization from B1 Nursing Care. Where transportation occurs, the following applies and the employee acknowledges and agrees:

• The employee will not transport any client in a personal vehicle without prior written authorization from B1 Nursing Care.
• The employee must maintain a valid driver's license and personal automobile liability insurance meeting or exceeding state minimum requirements at all times while employed.
• The employee's personal automobile insurance is the primary and sole coverage for the operation of the employee's personal vehicle. B1 Nursing Care does not insure employees' personal vehicles and provides no coverage for their use.
• The employee is solely responsible for the safe operation of any vehicle he or she drives, and assumes full responsibility for any traffic violations, accidents, injuries, or property damage arising from the employee's operation of a personal vehicle.
• The employee agrees that B1 Nursing Care is not responsible or liable for claims, damages, or losses arising from the employee's operation of a personal vehicle.

B1 Nursing Care is committed to the safety of both clients and staff. Safe client handling protects everyone. By signing below, the employee acknowledges and agrees to the following:

• The employee will use proper body mechanics and all provided assistive or mechanical lifting equipment when moving, transferring, or repositioning a client.
• The employee will not attempt any lift, transfer, or task that exceeds safe limits or that the employee cannot perform safely alone, and will request additional assistance or equipment when needed.
• The employee will follow each client's written plan of care and will not perform any lift or transfer prohibited by that plan.
• The employee will complete any required safe-handling training before performing client transfers.
• The employee will immediately report to a supervisor any unsafe condition, any inability to safely perform a task, and any injury — to the employee or the client — no matter how minor.

The employee understands that performing an unauthorized or unsafe lift in violation of this policy is grounds for disciplinary action, up to and including termination. The employee agrees to assume personal responsibility for injuries or damages that result from the employee's failure to follow this policy or from performing tasks outside the assigned plan of care.

By signing below, the employee acknowledges and agrees to the following:

• The employee has received, read, and understands B1 Nursing Care's policies, including the Drug & Alcohol Use Policy, Infectious Disease Control Policy, Transportation Policy, and Safe Lifting & Client Handling Policy, and agrees to comply with all company policies as a condition of employment.
• The employee agrees to perform only those duties assigned and authorized by B1 Nursing Care, and to follow each client's plan of care.
• The employee assumes full personal responsibility for his or her own acts, omissions, and conduct that occur outside the scope of assigned duties or in violation of company policy, and agrees to hold B1 Nursing Care harmless for any such acts, omissions, or conduct.
• The employee agrees to promptly report any incident, injury, accident, or unsafe condition in accordance with company procedures.

Nothing in this acknowledgment waives any right or remedy provided to the employee under applicable workers' compensation law or other law, or alters the at-will nature of employment.

The following policies apply to all employees of B1 Nursing Care as a condition of employment. Please read each policy carefully and sign the Policy Acknowledgment that follows. Violation of any policy may result in disciplinary action, up to and including termination and, where applicable, referral to law enforcement.

B1 Nursing Care maintains a zero-tolerance policy toward theft. Employees may not take, misuse, or remove any property that does not belong to them, including property of the company, its clients, client family members, or coworkers.

• Prohibited theft includes, without limitation: money or valuables; medications or medical supplies; food or household goods; equipment or company property; and a client's or coworker's personal belongings.
• Time theft is prohibited, including falsifying time records, clocking in for another person, or billing time not actually worked.
• Unauthorized use of a client's or the company's property, funds, credit cards, or accounts is theft.

Any employee who commits theft is subject to immediate termination and may be reported to law enforcement for criminal prosecution. Suspected theft must be reported to a supervisor immediately.

To protect the safety of clients, families, and staff, B1 Nursing Care prohibits employees from carrying, possessing, or using any weapon while performing job duties.

• Employees may not possess or carry firearms, knives (other than ordinary tools required for a task), or any other weapon while providing services in a client's home, in any company office or facility, or while otherwise on duty.
• Brandishing, threatening with, or using any object as a weapon is strictly prohibited and is grounds for immediate termination.
• This policy does not prohibit an employee from lawfully transporting or storing a firearm within a locked, privately owned motor vehicle, consistent with Mississippi law.

Violation of this policy is grounds for immediate termination and may be reported to law enforcement.

B1 Nursing Care is committed to a workplace free of hostility, violence, harassment, and intimidation. Every client, family member, coworker, and supervisor is to be treated with respect.

• Prohibited conduct includes threats, intimidation, verbal or physical aggression, bullying, hostile or abusive language, and any act or threat of violence toward clients, families, coworkers, or the public.
• Harassment of any kind — including sexual harassment or harassment based on race, color, religion, sex, national origin, age, disability, or other protected status — is prohibited.
• Retaliation against anyone who reports a concern in good faith is prohibited.

Employees who experience or witness hostile, threatening, or violent behavior must report it to a supervisor or the Compliance Director immediately. Threats or acts of violence are grounds for immediate termination and may be reported to law enforcement.

B1 Nursing Care complies with the Health Insurance Portability and Accountability Act (HIPAA) and protects the privacy and security of all protected health information (PHI). Client information is strictly confidential.

• Employees may access and use client information only as necessary to perform their assigned duties (the "minimum necessary" standard).
• Employees may not disclose any client's PHI to anyone not authorized to receive it, including family, friends, or other clients.
• Client information must never be posted or discussed on social media, text, email, or any public forum.
• Written and electronic records must be kept secure; devices must be protected; and records must not be left where others can view them.
• Suspected privacy breaches must be reported to the Compliance Director immediately.

The obligation to protect client confidentiality continues after employment ends. Violations may result in termination and civil or criminal penalties under federal law.

Employment with B1 Nursing Care is governed by the laws of the State of Mississippi. The employee acknowledges and agrees to the following:

• At-Will Employment. Mississippi is an at-will employment state. Employment may be ended at any time, with or without cause or notice, by either the employee or the company. No policy or document creates a contract of employment or guarantees employment for any period.
• Right to Work. Mississippi is a right-to-work state; employment is not conditioned on membership or non-membership in any labor organization.
• Management Rights. The company reserves the right to assign, schedule, and reassign work; to establish, modify, and enforce policies, procedures, and job requirements; and to determine staffing, pay, and business operations.
• Screening & Testing. The company reserves the right to require background checks and pre-employment and ongoing drug and alcohol testing, within the limits of applicable law.
• Right to Modify. The company reserves the right to revise, add to, or discontinue any policy at any time, with or without notice.

Nothing in these policies waives any right or remedy provided to the employee under applicable Mississippi or federal law.

To protect both clients and employees and to prevent any appearance of exploitation, B1 Nursing Care prohibits employees from receiving money or gifts from clients or their families.

• Employees may not accept cash, tips, gifts, loans, or items of value from clients or their families.
• Employees may not borrow money or property from a client, lend money to a client, or enter into any financial transaction with a client.
• Employees may not use a client's money, checks, credit cards, or accounts except as specifically authorized in the plan of care for the client's own needs, with proper documentation and receipts.
• Employees may not accept being named as a beneficiary, heir, or recipient in a client's will, insurance, or estate, and may not solicit or accept property from a client.

If a client or family attempts to give an employee money or a gift, the employee must respectfully decline and report it to a supervisor. Violation of this policy is grounds for termination and may be reported to the appropriate authorities.

I acknowledge that I have received, read, and understand the following policies of B1 Nursing Care, and I agree to comply with each of them as a condition of my employment: Theft Policy; No Weapons Policy; Anti-

Hostility & Workplace Violence Policy; HIPAA & Confidentiality Policy; Company Rights & Employment Provisions (State of Mississippi); and No Cash or Gifts From Clients Policy. I understand that violation of any of these policies may result in disciplinary action, up to and including termination of employment and, where applicable, referral to law enforcement. I understand that my employment is at-will and that these policies do not create a contract of employment.

Completion of this section is entirely voluntary and will be kept separate from your application. This information is used only for equal-opportunity record-keeping and will not be used in any hiring decision. Declining to provide it will not subject you to any adverse treatment.

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