Agency Agreement

1. I understand that I will be required to provide, in a timely manner, all necessary documentation, including but not limited to, my resume, licenses, certificates, physical report, drug screens, background checks etc. in order for me to be approved for any travel/per‐diem assignment with a Agency client. Failure to do so may result in termination of my employment with the Agency.

2. I understand that as part of the above approval process, an investigation may be made in which information is obtained through personal interviews, and a review of information held by law enforcement or other government agencies. I hereby authorize you to verify my past employment and education, criminal records, motor vehicle records, personal references, and other job related data provided on this application, or via the interview process. I authorize appropriate individuals, companies, institutions or agencies to release information, and I release them from any liability as a result of such inquiries or disclosure.

3. I understand that I am not in any obligation to accept an assignment offered by the Agency. But once I accept a travel/per‐diem assignment, I pledge the following:


a. To cooperate with the Client’s reasonable instructions and accept the direction, supervision, and control of any and all responsible person(s) in the Client facility/Home

b. To observe any relevant rules and regulations of the Client facility/Home to which my attention has either been drawn or which I might reasonably be expected to ascertain

c. To not engage in any conduct detrimental to the interests of the Client

d. To honor my commitment to complete any assignment/shift that I have accepted. If I fail to complete any assignment/shift, I understand that I have voluntarily terminated my employment with the Agency.


4. I understand that I am to contact my Agency representative immediately if I am experiencing any difficulty on my assignment/shift or if there are any changes in job description, location, or working hours by the Client.

5. I am to contact the Agency immediately if it is impossible for me to report to work. The Agency staffers are available 24/7, so you may call us any time of the day or night. Please call us in enough time that we might schedule a replacement for your position. I understand that if I do not report to my assignment and/or do not call the Agency, I have voluntarily terminated my employment with the Agency. I understand that I must notify the Agency beforehand if I am late for work or take time off, failing which I understand that I have voluntarily terminated my employment with the Agency.

6. If I am confirmed for a shift and I cancel my availability for that shift later than 2 hours before the start of that shift, then I may be required to pay a late cancellation fee equivalent to 4 hours times the Client bill rate. The late cancellation penalty will be applied to my payroll by deducting the full amount from the next payroll cycle.

7. While on a temporary assignment, if the Client offers me a permanent position or if one is discussed, I will contact my Agency representative immediately. All fees and conditions are to be handled by the Agency. It is unlikely that one of the Agencys’ Clients would ask me to work for them on my own rather than through the Agency. I understand that if I go work directly for a Client within one year of my temporary assignment, I will be responsible for paying all employment fees or charges incurred.

8. I understand that the Agency is committed to maintaining a safe working environment for all employees. If I am ever asked to do anything unsafe, observe unsafe working conditions, or am injured at work, I will contact the Agency immediately. Furthermore, I agree to perform all work in as safe a manner as possible. If I experience an accident or injury while working for the Agency, I will notify the Agency within 48 hours of the incident.

9. I understand that all client and patient information supplied to me shall be held in strictest confidence, and all product and materials, including, but not limited to, patent records, client records, documentation, reports, charts, manuals, letters, programs and any and all other sources of information given to me or obtained by me from the client or at the work location will be returned to the Client at the completion of my shift/assignment. I also agree not to disclose any company trade secrets or confidential information of the Agency or its Client to any other entities or individuals.

10. The Agency issues paychecks every Week for the hours worked in the preceding week. I understand I am required to present to the Agency, EVERY MONDAY, an actual timesheet signed by the Client in order to have my paycheck issued on Friday. If I fail to provide such time card in a prompt manner, I understand that it will result in my pay being carried over to the next pay period.

11. I understand that ALL overtime hours must be pre‐authorized by the Agency. If I work overtime that is not pre‐ authorized, I accept and understand that I will not be paid for those hours. I further understand that all matters relating to the Agency wages and rates are confidential and I will not discuss them with Clients, other employees of client or the Agency, or any co‐worker at the work location, and in doing so, could result in my immediate dismissal from the assignment and possible termination from the Agency.

12. I understand that any monies due the Agency resulting from loans, advances, damaged property, lost property including badges, or unauthorized use of property, including, but not limited to late shift cancellation penalties, the unauthorized or improper use of telephone, postage meters, computer equipment, software etc. at the Agency or the Client, may be deducted from my paycheck(s).

13. When assigned to a contract or per‐diem assignment, I understand that within 24 hours from the last day of my assignment, I am required to confirm my availability for a new assignment. I understand that it must be in WRITING ONLY, email, or fax. I accept and understand that when I do not email or fax my availability within the specified time period, I am refusing further work with the Agency and thereby voluntarily resigning from my employment with the Agency. I understand that my unemployment benefits may be denied when I voluntarily resign my employment with any company.

14. I understand that the assignment is based on the agreement between the Agency Staffing and the Client Facility. Client Facility has the right and privilege to cancel or modify the terms of the assignment with or without notice. I understand and accept that the Agency will not be liable for any consequential damages, losses, expenses, inconveniences, or loss of alternative employment as a result of Client Facility’s changes to the assignment. I understand the Agency Staffing will be obligated to pay only for the approved hours worked as indicated on a client‐approved timesheet.

15. I understand and agree that in case of dispute or controversy arising from or relating to this Employment Agreement, the matter shall be referred for resolution to the Agency, whose decision shall be final and binding on both parties.