Please review the following Employment Application Acknowledgement before submitting your application:

Employment Application Certification

I affirm that the information provided on my application for employment with IHC (and any resume submitted and/or supporting documents) is/are true and complete and that I have withheld nothing that would, if disclosed, affect my application unfavorably. I understand that any false, misleading, or omitted information may disqualify me from further consideration for employment and may result in dismissal if discovered later.

Any information provided to IHC on this application or as part of the application process or if offered employment by IHC, any information relating to my employment with IHC including, but not limited to, the contents of my personal file, may be made available to clients, prospective clients, and government, insurance or other appropriate agencies or third parties as requested, or required by applicable law. I understand that completion of my application guarantee employment with IHC. I understand that neither my application nor any other document constitutes a contract of employment for a specific term and that any employment relationship that may be established will be “at will” and may be terminated at any time, for any or no reason, by me or IHC. I understand that no representative of IHC has any authority to enter into any agreement for employment with me contrary to the foregoing.

Employment Relationship

If hired by IHC, I must abide by all IHC’s rules and regulations as set forth in the Orientation Packet, which, other than the “at will” employment policy, may be changed without notice at the discretion of IHC. I understand that: (1) as a benefit to me, IHC may offer the opportunity to enhance my skills through training programs. These programs do not constitute an offer, promise, or guarantee of future assignments. Training is strictly voluntary, and I may not be paid for time spent in training; (2) it is my responsibility to promptly inform IHC of any problems I encounter while on assignment with a client or any work-related accidents or injuries; (3) I will present a note from a healthcare provider for any medically related absence of two days or more; (4) I understand that I am required to get prior approval from the client and IHC to work more than 40 hours. Working 40+ hours without prior authorization may result in disciplinary action, including termination. (5) IHC may require me to submit to a drug and alcohol test prior to employment and a drug and alcohol test and/or medical examination at any time during my employment, to the extent permitted by applicable law, and I understand that a positive test result, or any refusal to submit to a drug test, may result in the termination of my employment and/or denial of workers’ compensation benefits and unemployment compensation benefits; (6) IHC may require consent to or authorize the disclosure of my criminal record and/or consumer credit report prior to employment and at any time during my employment, to the extent permitted by applicable law.

Communication and Information Systems Use Agreement

I understand that communication and information systems belonging to IHC and/or IHC’s customers (such as e-mail, internet, voicemail, etc.) are intended for legitimate business purposes and that I will not be afforded any privacy when using these systems. Any use of these systems for personal business is at the sole discretion of IHC or customer management and must be used in an appropriate and reasonable manner. Access to and use of these systems may be terminated at any time without notice. The use of these systems in an inappropriate or offensive manner (including sexually explicit words or images, racial epithets or slurs, and/or demeaning words or images that may be considered offensive to others) may result in termination of my assignment or employment.

Non-Disclosure and Assignment of Intellectual Property Rights Agreement

Without IHC’s prior written approval, I will not publish, use, copy, retain possession of, or disclose any proprietary or confidential information of any IHC customer. Upon completion of assignment, I will return to the customer all documents that may contain confidential customer information. In addition, I understand that the ownership of any work I create while on assignment will belong to IHC or its customer, and I will assign any intellectual property rights that arise from my work according to IHC request. Thus, my work on assignment will be considered “work made for hire”.

Notice of Assignment End

I am required to contact IHC after my assignment has ended. I must go to a local IHC branch and sign the Available Log placing me on available status prior to the end of the following business day. Failure to sign the Available Log and remain in contact with IHC indicating my availability for assignments will constitute a voluntary resignation that may affect unemployment benefits.

I must return any client property issued, including, but not limited to, security passes, keys or identification, upon completion of assignment, or I may be held responsible for any replacement costs or damages.

Drug and Alcohol Policy

Our extensive experience as an employer has found that a drug-free workplace is necessary for many reasons. Some of these reasons include a safer environment, legal obligations, reduced liability for IHC, and avoiding losses in productivity, absenteeism and healthcare. For all these reasons and more, IHC utilizes the following No-Drug Policy with regard to all assignments.

The sale, distribution, or use of illegal drugs on or off IHC property, or the use or possession of illegal drugs on IHC property or in an IHC vehicle will be grounds for termination and barred from employment with IHC.

This policy does not prohibit the use of prescribed drugs under the direction of a physician. When taking physician prescribed drugs or over-the-counter legal drugs, which may affect performance, associate should report such use to his or her immediate manager for determination of fitness-for-duty while on such medication.

The following person or personnel are subject to undergoing drug urine screening pursuant to the IHC No-Drug Policy:

• Any associate on assignment for IHC whose performance or behavior indicates that he or she may be unfit for duty and possibly abusing drugs or alcohol will be subject to drug and/or alcohol screening to determine fitness for duty. The associate will be immediately suspended without pay pending results of the screening and barred from IHC. If the screening reveals violation of this policy, the associate will be terminated immediately. If the screening produces a negative result (showing no measurable substance abuse), the associate will be reinstated to continue employment.
• Any associate who is involved in an accident or injury while performing duties on IHC property or IHC business away from IHC property, including IHC client property or business, will be subject to drug and/or alcohol screening, where allowed by state law. The associate will be allowed to continue to work pending the results of the screening tests. If the screening results come back positive, the associate will be terminated immediately. If the screening comes back negative (showing no measurable substance abuse), the associate will be allowed to continue employment without change. Failure to submit to screening will result in immediate dismissal.

Authorization and Consent

I acknowledge that IHC has requested that I submit to drug and alcohol testing and/or a search of my person, my work area, my personal property and/or my automobile. I understand that I may refuse to submit to testing or to a search. I understand that my employment may be terminated if the test results are positive, if I refuse to consent to testing or to a search, or if there is evidence which indicates (in the opinion of IHC or of the testing laboratory) that the testing sample was tampered with, substituted or altered in any way. I understand that the test will detect alcohol, illegal drugs, other non-prescribed intoxicants and some prescription drugs, and I understand that positive result for alcohol, illegal drugs or prescription drugs for which I lack a valid prescription will be grounds for termination and disqualification from workers’ compensation benefits and unemployment compensation benefits. I understand that a positive test result caused by the appropriate use of legally prescribed medications that do not cause unsafe or unacceptable performance will not affect my employment.

I will hold harmless IHC, IHC’s customers, and any testing laboratory that IHC might use. I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if an IHC or laboratory representatives makes an error in the administration or analysis of the test or the reporting of results. I will hold harmless IHC, IHC’s customers, and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of IHC’s policy and procedures as explained in IHC’s Release and Consent for Drug Testing.

I voluntarily consent to be tested for drugs and alcohol and/or to a search of my person, my work area, my personal property and/or my automobile. I voluntarily consent to testing by any method that IHC deems reasonable and reliable, including urinalysis, blood testing and breath analysis. I also consent to the release of the testing results to IHC, or any IHC affiliate or client that employs me.

Equal Employment Opportunity Policy

IHC is committed to equal employment opportunity for all qualified persons and prohibits discrimination based on race, color, gender, age, religion, national origin, ancestry, pregnancy, disability, service in the uniformed services or any other classification protected by law.

Acknowledgement

I certify that I have completed this form to the best of my ability. I understand that falsification of information may lead to ineligibility for or termination of employment. I have read and understand this agreement, and I agree to its terms.