Acknowledgement of Understanding of Job Description and Risk of Blood Borne Pathogen

I have read and understand the appropriate job description for the position I am applying for and agree to fulfill the position’s
responsibilities to meet the defined standards.

Risk of Exposure to Blood borne Pathogens: Classification I

Classification I jobs are those in which required tasks routinely involve a potential for mucous membranes or skin contact with
blood, body fluids, tissues or potential spills or splashes. Uses of appropriate measures are required for every healthcare provider
in these jobs.

______________________________________________________________________________
(Signature) Job Classification (Date)

______________________________________________________________________________
(Independent Nursing Services Representative) (Date)
 CONDITIONS OF EMPLOYMENT
(For Positions Requiring Licensure, Registration or Certification)

In order to ensure compliance with federal, state and other regulatory and accrediting
bodies. Independent Nursing Services requires agency contract staff whose positions
require licensure, registration or certification to obtain and maintain that status.
Independent Nursing Services needs to be notified immediately of any changes to that
status and show their current license, registration or certification upon renewal or as
requested.

It is the policy of Independent Nursing Services to ensure that all legally required
licenses, certifications and registrations required for employment with Independent
Nursing Services are kept current. To this end, Independent Nursing Services requires
that each agency contract staff required to be licensed, certified or registered in their
position with Independent Nursing Services, submit immediately upon renewal a copy of
their current license, registration or certificate to their agency (consequently Independent
Nursing Services). In addition, such documentation must be prominently displayed or
immediately available at all times. Failure to maintain licensure, certification or
registration as required will prohibit an employee from continuing in their assignment.

I have read the above policy requirement and agree to comply with its provisions.

________________________ ________________________
Employee Signature Employee Representative

________________________ ________________________
Date Date
Fax completed form to (586) 771-4205 or e mail Sheila@independentnursing.com

C:\Documents and Settings\Administrator\Desktop\Form for E signature info\CONDITIONS OF EMPLOYMENT.doc

 Confidential Information and Services Agreement
Our clients entrust Independent Nursing Services (“INS”) with important information relating to
their businesses. The nature of this relationship requires maintenance of confidentiality. In safeguarding the
information received, INS earns the respect and further trust of our clients and suppliers.

Independent Nursing Services’ staff has access to confidential patient information during the daily
performance of duties. The patient’s record and information should be accessed and read only as part of
staff’s normal job responsibilities and should never be divulged in any manner or for any reason outside of
the direct functions of staff’s job responsibilities. Violation of a patient’s privacy or disclosure of
confidential information will result in disciplinary action, up to and including termination, and also be
cause for other punitive action including possible criminal prosecution. You agree not to remove or make
copies of any Independent Nursing Services records, reports or documents without prior written
management approval. Your obligation to maintain confidentiality continues even after you leave our
employ.

Any violation of confidentiality seriously injures Independent Nursing Services’ reputation and
effectiveness. Therefore, please do not discuss Independent Nursing Services, business with anyone who
does not work for us, and never discuss business transactions with anyone who does not have a direct
association with the transaction. Even casual remarks can be misinterpreted and repeated, so develop the
personal discipline necessary to maintain confidentiality. If someone questions you outside of Independent
Nursing Services, or your department and you are concerned about the appropriateness of giving them
certain information, remember that you are not required to answer, and that we do not wish you to do so.
Instead, as politely as possible, refer the request to your manager or to the President.

You agree to use your best efforts to promote the business interest and goals of INS. You
agree not to use your employment with INS to solicit or acquire further business with any client or
customer of INS. During the term of your employment with INS and for a period of 12 months after
the termination of your employment for any reason, you agree that you will not provide services to
any INS client or patient directly or Indirectly, Through another Agency, Individual, Entity other
than Independent Nursing Services, or solicit any other individual or entity to do so, other than
through INS. INS clients and patients are defined as past or present INS clients or patients to whom
you have personally provided services while employed by INS. Upon termination of your
employment, for any reason, you agree not to compete with INS, which is defined as using any
information, including any trade secrets as defined above, obtained during your tenure with INS,
involving the staffing or home care business for a period of 12 months within a radius of 50 miles of
any location at which you provided services.

The laws of the State of Michigan shall govern this Agreement. If any provision of this
Agreement is determined to be unenforceable or invalid, the remaining provisions of this Agreement shall
not be affected and shall remain in full force and effect. The terms and conditions of this Agreement
survive termination of your employment with INS. Any failure to insist upon your compliance with the
terms of the Agreement shall not constitute a waiver of INS rights. Nothing in this Agreement affects the
“at-will” status of your employment.

Your signature below implies that you understand this Agreement and agree to abide by it, and are
subject to the disciplinary actions noted above.

_____________________________________________________________________________
Employee Signature Date

_____________________________________________________________________________
Independent Nursing Services Representative Signature Date

Fax completed form to (586) 771-4205 or e mail Sheila@independentnursing.com

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2005.doc
 Authorization for Pre-Employment Credentialing and Testing
DRUG TESTING.
INS may conduct drug testing of job applicants’ pre-employment and randomly thereafter. Should this company consider you for
employment, you may be contacted regarding the time and location of the pre-employment drug test. Refusal to take the drug test or
failing the drug test can disqualify you from further consideration for a position.

REFERENCE CHECK AUTHORIZATION

I voluntarily authorize my previous employers to verify the information requested and any other information
regarding my job performance and release the employer listed from any liability for issuing such information.

CRIMINAL BACKGROUND CHECK

I understand that in connection with my application for employment, and/or continuous employment, Independent Nursing Services,
Inc. (INS), their agents, assigns or any other authorized third parties (collectively, the “Investigators”) may be performing, requesting,
obtaining or conducting a background check on me. The scope of the background check may include an inquiry into my employment
history, education, general character or reputation, work experience, driving, criminal and credit histories and such other information
(the “Information”) as may be required.
I understand that INS may rely on any part or all of this Information in determining whether to extend an offer of
employment to me. I further understand that if any adverse action is taken by INS, or if INS chooses not to extend an offer of
employment to me based upon the Information, that I will be provided a copy of such information along with a summary of my rights
under the Fair Credit Reporting Act.

AUTHORIZATION AND UNDERSTANDING

I certify that the information given herein is true and complete without qualification. I understand that INS may investigate my work
and personal history and verify all data given on this application, on related papers, and in interviews, and I authorize INS to do the
same. This inquiry may include information as to my character, general reputation and personal characteristics, and I consent to the
conduct of this inquiry and to the consideration of any statements of references or former employers that are given in response to the
inquiry. I authorize all individuals, school and employers named therein, except as specifically limited on this application, to provide
information requested about me, and I release them from liability for damages in providing this information. I understand and
acknowledge that INS can terminate my employment if I have provided incomplete, inaccurate, untrue or misleading information in
this application or on any other document or form at any time during my employment.

If terminated, I authorize INS to use any information in its possession concerning me for reference purposes and/or if legally required
to furnish any information, including disclosure of information to any third party, future employer or prospective employer, without
receiving any prior notice, and I release INS from any liability in connection with such use or disclosure.

In consideration of my employment, I agree to conform to the rules and regulations of INS and the directions of its Supervisors. I
understand and acknowledge that, if employed, unless my employment becomes subject to a collective bargaining agreement, my
employment and compensation will be at the will of INS and can be terminated, with or without cause, and with or without notice, at
anytime at the option of either INS or myself.

I further understand that my employment is conditional until such time as the results of any pre-employment drug testing, criminal
background check and references if any is required, are known. I also understand and acknowledge that, as a part of the hiring process
and throughout my employment, if hired, I may be required to submit to medical/physical examinations at the employer’s discretion
and expense.

EMPLOYEE ACKNOWLEDGMENT _______________________________________

DATED________________________

Fax completed form to (586) 771-4205 or e mail Dan@independentnursing.com

EMPLOYEE ACKNOWLEDGMENT AND RECEIPT
I acknowledge receipt of the Independent Nursing Services, Inc. Employee Handbook. I agree to conform to the rules and regulations of the
company as set forth in the Handbook that is incorporated herein.

I have entered into my employment relationship with INS voluntarily and acknowledge that there is no specified length of employment.
Accordingly, either INS or I can terminate the relationship at will, with or without cause, at any time.

All employment at Independent Nursing Services, Inc. is "at will."

At-will employment means that the Company can terminate your employment for any reason or no reason, with or without cause, at any time,
without any advance warning or notice, and without any right of review outside the company, except as permitted by statute.

This Handbook replaces any prior policy statements, practices, and oral statements that the Company would employ any employee on other
than at-will bases. Nothing in this Handbook is intended or is to be construed as contrary to the at-will nature of employment.

Furthermore, I acknowledge that this handbook is neither a contract of employment nor a legal document. I have received the handbook, and I
understand that it is my responsibility to read and comply with the policies contained in this handbook and any revisions made to it.

I acknowledge that I am responsible for reviewing the Handbook and directing any questions I may have with respect to such review with the
Company's designated personal representative administering such Handbook. I agree that any action or claim against the Company arising out
of or in any way related to my employment or termination of employment, including, but not limited to, claims arising under state or federal
civil rights statures, must be brought within 180 days of the event giving rise to the claim. I waive any limitation periods to the contrary. I
further understand that as a temporary assignment employee, work is available to me and it is my responsibility to contact and
schedule work with Independent Nursing Services, Inc.

_____________________________ ____________________________________
“INS” Representative/ Date Employee's Signature/Date
 Employee Handbook

MISSION STATEMENT
To provide a service of quality, value and integrity that will contribute to
the benefit of the health care community and our employees.
“Making Excellence a Habit”

VISION STATEMENT
To provide a service of value to the community with the potential for personal
growth and security for our staff. We want our people to feel involved and
satisfied with their accomplishments. We want our people to be proud to work
with us and know their contributions are valued
“Setting the Pace”

Values
Integrity, Diversity, Personal Responsibility
Team Oriented, and Respect.

G:\Human Resources\EMPFILE\Emplyee Handbook\Emp Hand Book-MI Emplyees.doc

Welcome
This handbook was developed to acquaint you with INS and provide you with information about working
conditions, employee benefits, and some of the policies affecting your employment. You should read, understand,
and comply with all provisions of the handbook. It describes many of your responsibilities as an employee and
outlines the programs developed by INS to benefit employees. One of our objectives is to provide a work
environment that is conducive to personal and professional growth.

As INS continues to grow, the need may arise to change policies described in the handbook. INS therefore reserves
the right to revise, supplement, or rescind any policies or portion of the handbook from time to time, as it deems
appropriate, in its sole and absolute discretion. Every effort will be made to keep you informed through suitable
lines of communication, including postings on the Independent Nursing Services, Inc. bulletin boards and/or notices
sent directly to you.

Nature of Employment
This handbook cannot anticipate every situation or answer every question about employment. It is not an
employment contract and is not intended to create contractual obligations of any kind. Neither the employee nor
INS is bound to continue the employment relationship if either chooses, at its will, to end the relationship at any
time.

In order to retain necessary flexibility in the administration of policies and procedures, INS reserves the rights to
change, revise, or eliminate any of the policies and/or benefits described in this handbook. The only recognized
deviations from the stated policies are those authorized and signed by the chief executive officer of INS.

At-Will Employment
Independent Nursing Services has an at-will employment policy, which means that the term of employment is for
no definite period and may be terminated by the employee or by the Independent Nursing Services at any time and
for any reason, with or without cause or advance notice.

Conflicts of Interest
Employees have an obligation to conduct business within guidelines that prohibit actual or potential conflicts of
interest. This policy establishes only the framework within which INS wishes the business to operate. The purpose
of these guidelines is to provide general direction so that employee can seek further clarification on issues related to
the subject of acceptable standards of operation.

Transactions with outside firms must be conducted within a framework established and controlled by the executive
level of INS. Business dealings with outside firms should not result in unusual gains for those firms. Unusual gain
refers to bribes, product bonuses, special fringe benefits, unusual price breaks, and other windfalls designed to
ultimately benefit the employer, the employee, or both. Promotional plans that could be interpreted to involve
unusual gain require specific executive level approval.

Personal gain may result not only in cases where an employee or relative has a significant ownership in a firm with
which INS does business but also when an employee or relative receives any kickback, bribe, substantial gift, or
special consideration as a result of any transaction or business dealings involving INS or its clients. The materials,
products, designs, plans, ideas, and data of INS are the property of INS and should never be given to an outside firm
or individual except through normal channels and with appropriate authorization. The same is true for all clients of
INS to whom you are assigned. Any improper transfer of material or disclosure of information, even though it is
not apparent that an employee has personally gained by such action, constitutes unacceptable conduct. Any
employee who participates in such a proactive will be subject to disciplinary action, up to and including termination
of employment and legal action.

2
Non-Disclosure
The protection of confidential business information and trade secrets is vital to the interests and the success of INS
and that of its clients to whom you are assigned. Such confidential information includes, but is not limited to, the
following examples:

Compensation data Research and development strategies

Customer Lists Scientific data
Financial information Marketing strategies
New materials research Technological data
Pending projects and proposals Technological prototypes

All employees may be required to sign a non-disclosure agreement as a condition of employment. Any employee
who disclosed trade secrets or confidential business information will be subject to disciplinary action, up to and
including termination of employment and legal action, even if he or she does not actually benefit from the disclosed
information.

Employment Categories
It is the intent of INS to clarify the definitions of employment classifications so that employees understand their
employment status and benefit eligibility. These classifications do not guarantee employment for any specified
period of time. Accordingly, the right to terminate the employment relationship at any time is retained by both the
employee and INS. Employment categories, job classifications, job descriptions, qualifications for positions,
minimum requirements for positions, relationships to lines of authority and accountability shall be determined and
modified at the sole discretion of INS.
Each employee is designated as either NONEXEMPT or EXEMPT from federal and state wage and hour laws.
NONEXEMPT employees are entitled to overtime pay under the specific provisions of federal and state laws.
EXEMPT employees are excluded from specific provisions of federal and state wage and hour laws.

Employment Applications
INS relies upon the accuracy of information contained in the employment application, as well as the accuracy of
other data presented throughout the hiring process and employment. Any misrepresentation, falsifications, or
omissions in any of this information or data may result in INS exclusion of the individual from further consideration
for employment or, if the person has been hired, termination of employment.

Office Hours
Business hours are 8:30 a.m. to 5:00 p.m., Monday through Friday. Questions regarding paychecks, availability,
scheduling, etc. should be discussed during regular office hours.

INS management is available 24 hours a day, however we ask that you reserve all after hour calls for emergencies.
To reach the Scheduling Coordinator after business hours dial (586) 771-4097, and leave a message. The
Scheduling Coordinator will be contacted immediately and return your call.
A cancellation is considered an emergency.

Orientation
You will be compensated for attending the hospital orientation program at the designated orientation rate. The hours
for orientation may vary in order to comply with hospital requirements. All Independent Nursing Services, Inc.
employees are responsible for reviewing, understanding and complying with the policies/procedures governing the
individual client/facility setting, and are required to function under these set policies at all times.

Benefit Delay Period

There is a benefit delay period of ninety (90) days for all employees. You will have a chance to adapt to your work
and to get to know the people with whom you will be working. Your immediate supervisor at the completion of

3
your benefit delay period will perform a formal review. If you are retained as a full-time employee, you will then be
eligible for company benefits.

Employee Benefits
Eligible employees at INS are provided a wide range of benefits. A number of the programs (such as Social
Security, workers’ Compensation, state disability, and unemployment insurance) cover all employees in the manner
prescribed by law. Benefits eligibility is dependent upon a variety of factors, including employee classification, and
your supervisor can identify the programs for which you are eligible. Details of many of these programs can be
found elsewhere in the employee handbook. Eligibly and coverage for any company sponsored or voluntary benefits
are also determined by the terms of the written plan itself.

The following is the paid benefits allocated to INS employees scheduled to work 40 hours a week.

Company Sponsored
Employee Health Coverage
Pharmacy and Prescription Drug Card

Voluntary Electives
Direct Deposit
Dental Coverage
Flexible Spending Account
AFLAC
Some benefit programs require contributions from employees.

Holidays
Shifts recognized as Holidays by the Agency and worked are paid as time and one-half of the regular rates.

Employment Status
Independent Nursing Services, Inc. recognizes three (3) classifications of employment status:

* Active
* Inactive
* Terminated

The following lists the criteria that must be met in each classification:

Active Status
* According to policy, license to practice in the State of Michigan
* Current TB test results
* Working the minimum required hours per pay period
* Working telephone in his/her place of residence
• Reliable transportation
• Current CPR

4
Inactive Status
* At employee's request
• When an employee has failed to work the minimum required hours per pay period
• No longer has a working telephone in place of residence
* Transportation to and from assignment becomes unreliable

Terminated Status
Voluntary

* Employee request
* TB test and/or professional license not kept up to date according to policy
* Employee has failed to meet minimum hours required to remain active

Involuntary

* Employer decision with or without notice

* Policy violations
* New employee refusal of assignment (based on assignment suited to employee's skills)

Employees who have been terminated will NOT be eligible for rehire.

Weekly Time Records

When completing your time slip, use a ballpoint pen to ensure legible copies of each. Please make ALL attempts to
use one time slip for each client/ facility for each workweek. The top white copy is to be mailed or faxed to our
office. The middle yellow copy is for your records and the bottom pink copy is for the client/facility.

Remember that completed time slips must be received in the Independent Nursing Services, Inc. office no later
than 12:00 p.m., noon the Monday following completion of the previous workweek. Make sure that your time slip
is accurate and complete. A sample completed time slip has been provided to you at the time of your Agency
orientation.

Incomplete, incorrect or illegible time slips will delay your pay. Independent Nursing Services, Inc. is not
responsible in any way for delays in the U. S. Postal service. It is your responsibility to make sure our office
receives your time slips. Your paycheck will not be issued on Friday if we have not received your time slip by
12:00 p.m. (Noon), Monday. However, a check will be issued the following payday, upon receipt of the late
time slip.

If you lose or forget to obtain a signature on your time slip, you must return to the Hospital or Extended
Care Facility to have a duplicate signed before you can be paid. Carry extra Time Slips with you for
emergencies!
Dishonesty, falsification, alteration or any misrepresentation of time slip will result in immediate
termination.

5
Pay Periods And Paychecks
Your pay is very important to you and to us. Our pay structure is designed to fairly compensate our employees for
their skills, abilities, performance and length of service with us. In addition, we will periodically review our wage
and salary levels to assess their competitiveness with the appropriate labor market.

The standard pay period for Independent Nursing Services, Inc. is weekly, from Sunday through the following
Saturday of each workweek.

Payroll checks will be available for pick up on Friday between 12:00 PM- 4:00 PM. All remaining checks will be
mailed by 4:00 PM Friday. Please be aware that address changes must be submitted to the payroll department as
soon as possible to prevent a delay in receiving your check.

In accordance with the requirements of Federal, State and local laws, deductions will be taken automatically from
your paycheck for Federal, State and local taxes.

Please handle all payroll questions during regular business hours.

Administrative Pay Corrections

INS takes all reasonable steps to assure that employees receive the correct amount of pay in each paycheck and that
employees are paid promptly on the scheduled payday.
In the unlikely event that there is an error in the amount of pay, the employee should promptly bring the discrepancy
to the attention of INS so that corrections can be made as quickly as possible. Once underpayments are identified,
they will be corrected in the next regular paycheck.
Overpayments will also be corrected in the next regular paycheck unless this presents a burden to the employee
(where there is a substantial amount owed). In this case, INS will attempt to arrange a schedule of repayments with
the employee to minimize the inconvenience to all involved.

Overtime
When operating requirements or other needs cannot be met during regular working hours, employees may be
scheduled to work overtime hours. When possible, advance notification of these mandatory assignments will be
provided. All overtime work must receive the supervisor’s prior authorization. Overtime assignments will be
distributed as equitable as practical to all employees qualified to perform the required work.

Overtime compensation is paid to all nonexempt employees in accordance with federal and state wage and hour
restrictions. As required by law, overtime pay is based on actual hours worked. Overtime will be paid after the
employee has worked more than 40 hours in one workweek.

Safety
To provide a safe and healthful work environment for employees, customers, and visitors, INS has established a
workplace safety program. This program is a top priority for INS. INS provides information to employees about
workplace safety and health issues through regular internal communication channels, such as supervisor-employee
meetings, bulletin board postings, memos, or other written communications.

Each employee is expected to obey safety rules and to exercise caution in all work activities. Employees must
immediately report unsafe condition to the appropriate supervisor. Employees, who violate safety standards, who
cause hazardous or dangerous situations, or fail where appropriate, safety equipment, may be subject to disciplinary
action, up to and including termination of employment.

6
In the case of accidents that result in injury, regardless how insignificant the injury may appear, employees must
immediately notify the Safety Department or the appropriate supervisor. Notification must be made in writing on
the forms provided. Such reports are necessary to comply with laws and initiate insurance and Worker’s
Compensation benefits.

Leave of Absence
An approved leave of absence is required for an absence. The maximum amount of time granted for any leave is
three months. Regular full-time and part-time employees who have completed one year of employment are eligible
to apply for a leave of absence. Leaves of absence are granted or denied at the sole discretion of INS. Requests for
leaves of absence must be in writing on appropriate forms acknowledged by the employee’s supervisor. An
extended absence from work without completed forms and prior approval constitutes an unauthorized leave and will
be considered a voluntary resignation.
It is INS policy to grant leaves of absence to employees who have adequate reasons for the request, as determined at
the sole discretion of INS. A leave of absence does not guarantee return to duty at the conclusion of the leave.
INS will attempt, but will not be required to return the employee to the same position or one comparable.
Unpaid leaves of absence may be taken for the following reasons:
As soon as eligible employees become aware of a need for a leave of absence, they should request a leave from their
supervisor. Documentation in the form of a physician’s statement must be provided verifying the medical and/or
pregnancy disability and its beginning and expected ending dates. Any changes in this information should be
properly reported to INS. Employees returning from medical and/or pregnancy disability leave must provide a
physician’s verification of their fitness to return to work. If requested by INS, the employee must sign all necessary
authorizations so that the complete records of the treating physician and hospitals may be obtained. The employee
also may be required to submit to an examination by a physician designated by INS prior to, during, or at the end of
an approved leave of absence.

Family and Medical Leave

Family and Medical Leave Act (FMLA) provides covered employees up to 12 weeks of unpaid, job protected leave
to “eligible” employees for certain family and medical reasons. Employees are eligible if they have worked for a
covered employer for at least one year and for 1,250 hours over the previous 12 months.

Equal Opportunity Employment

INS believes in the principle of equal employment opportunity for all. This principle will be adhered to in order to
ensure that equal employment opportunity is available to all persons regardless of age, sex, color, race, national
origin, religion, veteran’s status, marital status, height, weight, citizenship status, or physical or mental handicap
unrelated to the employee’s ability to perform his/her job. These prohibitions are also required by federal and/or
state law: and this reaffirmation is not intended to create any contractual rights, new remedies or alter the
administrative requirements or limitation periods of state or federal laws.
Under the Michigan Handicappers’ Civil Rights Act, an employer has a legal obligation to accommodate an
employee’s or job applicant’s handicap unless the accommodation would impose an undue hardship on the
employer. A handicapper may allege a violation against an employer regarding a failure to accommodate his or her
handicap only if the handicapper notifies the employer in writing of the need for accommodation with 182 days
after the date the handicapper knew or reasonable should have known that an accommodation was needed.

A. Harassment Policy
As a part of INS policy of equal Opportunity employment, we prohibit abusing the dignity of anyone through
ethnic, racist, sexist, religious, age, handicap, height, weight, veteran or marital status, derogatory comments, slurs,
statements, jokes or other derogatory or objectionable conduct. Violation of this policy will subject the abuser to
prompt disciplinary action up to and including immediate discharge, at the sole discretion of INS.

It is illegal and against the policies of this company for any employee, male or females, to engage in actions which
sexually harass another employee by:

7
1. Making unwelcome sexual advances or requests for sexual favors or other verbal or physical conduct of a
sexual nature, a condition of the employee’s continued employment, or
2. Making submission to or rejection of such conduct the basis for employment decisions affecting the employee,
or
3. Creating an intimidating, hostile or offensive working environment by such conduct.

B. Complaint Procedure
Any employee who believes he or she has been the subject of any harassment as defined herein, including but not
limited to sexual harassment, should report in writing the alleged act immediately (within 48 hours after the alleged
harassment occurs). If someone other than the employee’s immediate supervisor did the alleged incident of
harassment and that supervisor did not participate and was unaware of said conduct; the employee should register
his or her complaint initially with his or her immediate supervisor. If the employee is dissatisfied with the
resolution by the supervisor or if the supervisor was involved in the conduct or if after notifying the supervisor the
alleged harassment continues to occur, the employee should contact the President.

Upon presentation of the complaint, an impartial investigation of all complaints will be undertaken immediately.
Any supervisor, agent or other employee who has been found, after appropriate investigation by the company, to
have harassed another employee will be subject to appropriate discipline up to and including immediate discharge at
the sole discretion of the company.

C. Non-Retaliation
The Company recognizes that the question of whether a particular action or incident is a purely personal, social
relationship without discriminatory employment impact requires a factual determination based on all facts and the
totality of the circumstances. Given the nature of this type of discrimination, the company recognizes also that false
allegations of harassment can have serious effects on innocent men and women. The company trusts that all
employees will continue to act responsible to establish a working environment free of discrimination. The company
encourages any employee to raise questions he or she may have regarding discrimination with the appropriate
official of the company.

INS not only prohibits harassment but also strictly prohibits any retaliation against an employee who, in good faith,
has registered a complaint under this procedure. Any supervisor, agent or employee of the company who, after
investigation has been determined to retaliate against any employee for utilizing the complaint procedure in this
policy will be subject to appropriate discipline up to and including immediate discharge at the sole discretion of the
company. If an employee believes he or she has been retaliated against for exercising his or her rights under this
policy, the employee should use the complaint procedure as set forth in “C” above.

Standards of Conduct
INS reserves the right to discipline or discharge an employee for unacceptable activities not specified in a Standard
of Conduct. The Standards of Conduct and Disciplinary Actions do not alter the at-will employment relationship.

By accepting employment with us, you have a responsibility to Independent Nursing Services, Inc. and to your
fellow employees to adhere to certain rules of behavior and conduct.
The purpose of these rules is not to restrict your rights, but rather to be certain that you understand what conduct are
expected and necessary. When each person is aware that he or she can fully depend upon fellow workers to follow
the rules of conduct, then our organization will be a better place to work for everyone.

Unacceptable Activities
If you have questions concerning any work or safety rule or any of the unacceptable activities listed, please see your
manager for an explanation.

Occurrences of any of the following violations, because of their seriousness, may result in immediate dismissal
without warning:

8
* Willful violation of any Independent Nursing Services, Inc. rule.
* Willful violation of security or safety rules or failure to observe safety rules or Independent Nursing Services,
Inc. safety practices; tampering with Independent Nursing Services, Inc. equipment or safety equipment.
* Negligence or any careless action, which endangers the life or safety of another person.
* The use of alcohol is prohibited, for the purpose of this Standard of Conduct, intoxicated or impaired by
alcohol means 0.02% blood alcohol concentration or above. Being intoxicated or under the influence of
controlled substance drugs while at work; use or possession or sale of controlled substance drugs in any
quantity while on Independent Nursing Services, Inc. Premises except medications prescribed by a physician
that do not impair work performance.
* Unauthorized possession of dangerous or illegal firearms, weapons or explosives on Independent Nursing
Services, Inc. property or while on duty.
* Engaging in criminal conduct or acts of violence, or making threats of violence toward anyone on
Independent Nursing Services, Inc. premises or when representing Independent Nursing Services, Inc.
fighting, or horseplay or provoking a fight on Independent Nursing Services, Inc. property, or negligent
damage of property.
* Insubordination or refusing to obey instructions properly issued by your manager pertaining to your work
refusal to help out on a special assignment. Refusing a drug or alcohol screen.
* Threatening, intimidating or coercing fellow employees on or off the premises -- at any time, for any purpose.
* Engaging in an act of sabotage; willfully or with gross negligence causing the destruction or damage of
Independent Nursing Services, Inc. property, or the property of fellow employees, clients, or visitors in any
manner.
* Theft of Independent Nursing Services, Inc. property or the property of fellow employees; unauthorized
possession or removal of any Independent Nursing Services, Inc. property, including documents, from the
premises without prior permission from management; unauthorized use of Independent Nursing Services, Inc.
equipment or property for personal reasons; using Independent Nursing Services, Inc. equipment for profit.
* Dishonesty; willful falsification or misrepresentation on your application for employment or other work
records; lying about sick or personal leave; falsifying reason for a leave of absence or other data requested by
Independent Nursing Services, Inc.; alteration of Independent Nursing Services, Inc. records or other
Independent Nursing Services, Inc. documents.
* Violating the non-disclosure agreement; giving confidential or proprietary Independent Nursing Services, Inc.
information to competitors or other organizations or to unauthorized Independent Nursing Services, Inc.
employees; working for a competing business while a Independent Nursing Services, Inc. employee; breach of
confidentiality of personnel information.
* Malicious gossip and/or spreading rumors; willfully restricting work output or encouraging others to do the
same.
* Lewd conduct or indecency on Independent Nursing Services, Inc. property.
* Conducting a lottery or gambling on Independent Nursing Services, Inc. premises.

Occurrences of any of the following activities, as well as violations of any Independent Nursing Services, Inc. rules
or policies, may be subject to disciplinary action, including possible immediate dismissal. This list is not all-
inclusive and, notwithstanding this list, all employees remain employed “at will.”

* NO CALL NO SHOW is cause for immediate dismissal.

* Unsatisfactory or careless work; failure to meet production or quality standards as explained to you by your
manager; mistakes due to carelessness or failure to get necessary instructions. All facility/client complaints
regarding work assignment will be investigated. If three facilities/clients put an employee on their “do not
return list” for any of the above, the results will be immediate termination.
* Any act of harassment, sexual, racial or other telling sexist or racial-type jokes making racial or ethnic slurs.
* Leaving work before the end of a workday or not being ready to work at the start of a workday without
approval of your manager; stopping work before time specified for such purposes.
* Sleeping on the job, loitering, or loafing during working hours.
* Excessive use of a facility or client’s telephone for personal calls.
* Leaving your workstation during your work hours without the permission of your manager, except to use the
rest room.
* Smoking in restricted areas or at non-designated times, as specified by department rules.

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* Creating or contributing to unsanitary conditions.
* Posting, removing or altering notices on any bulletin board on Facility or client's property without permission
of an officer of Independent Nursing Services, Inc.
* Failure to report an absence or late arrival, excessive absence or lateness.
* Buying Independent Nursing Services, Inc. merchandise for resale.
* Obscene or abusive language toward any manager, employee or customer; indifference or rudeness towards a
customer or fellow employee; any disorderly/antagonistic conduct on Independent Nursing Services, Inc.
premises.
* Speeding or careless driving of any Independent Nursing Services, Inc. vehicles.
* Failure to immediately report damage to, or an accident involving Independent Nursing Services, Inc.
equipment.
* Refusing a request for a random drug screen.
* Soliciting on behalf of any organization or for any purpose during the working time of the soliciting employee
or the solicited employee, selling merchandise or collecting funds of any kind for charities or others without
authorization during business hours.
* Failure to maintain a neat and clean appearance in terms of the standards established by your manager; any
departure from accepted conventional modes of dress or personal grooming; wearing improper or unsafe
clothing.
* Eating food and beverages in undesignated areas or at your workstation.
* Failure to use your timecard; alteration of your own timecard or records or attendance documents; punching or
altering another employee's timecard or records, or causing someone to alter your timecard or records.

Disciplinary Actions
The Discipline Policy applies to all active employees who have completed the introductory period of 90 working
days.
The steps in our progressive discipline procedure are:

Step # 1-Verbal Warning

Step # 2-Written Warning
Step # 3-Final warning
Step # 4-Dismissal

INS will depart from these progressive discipline steps when it believes that the circumstances warrant it.
INS will investigate each incident and determine, at its discretion, the appropriate discipline based on the severity of
the offense, the employee’s past record, and the penalties imposed for similar incidents on employees with similar
disciplinary records.

INDEPENDENT NURSING SERVICES’S

DRUG TESTING POLICY

Drug and Alcohol Use

It is INS desire to provide a drug-free, healthful, and safe workplace. To promote this goal, employees are required
to report to work in appropriate mental and physical condition to perform their jobs in a satisfactory manner.
While on INS premises and that of its clients, or conducting business-related activities off INS premises, no
employee may use, possess, distribute, sell, or be under the influence of alcohol or engage in the unlawful
manufacture, distribution, dispensation, possession, or use of illegal drugs. Violations of this policy may lead to
disciplinary action, up to and including immediate termination of employment, and/or required participation in a
substance abuse rehabilitation or treatment program. Such violations may also have legal consequences.
The legal use of prescribed drugs is permitted in the job only if it does not impair an employee’s ability to perform
the essential functions of the job effectively and in a safe manner that does not endanger other individuals in the
workplace.

10
Employees with questions or concerns about substance dependency or abuse are encouraged to discuss these matters
with their supervisor or the Human Resources Department to receive assistance or referrals to appropriate resources
in the community.
Employees with drug or alcohol problems that have not resulted in, and are not the immediate subject of
disciplinary action may request approval to take unpaid time off to participate in a rehabilitation or treatment
program. Leave may be granted if the employee agrees to abstain from use of the problem substance; abides by all
INS policies, rules, and prohibitions relating to conduct in the workplace; and if granting the leave will not cause
INS any undue hardship.
Employees with questions on this policy or issues related to drug or alcohol use in the workplace should raise their
concerns with their supervisor or the Human Resources Department without fear of reprisal.

1. Pre-employment testing paragraph:

All job applicants at this company will undergo testing for the presence of illegal drugs as a condition of
employment. Any applicant with a confirmed positive test result will be denied employment. This
company will not discriminate against applicants for employment because of a past history of drug abuse.
Therefore, individuals who have failed a pre-employment test may initiate another inquiry with the
company after a period of no less than six months, but must present themselves drug-free.

2. This company has adopted testing practices to identify employees who use illegal drugs either on or off the
job. It shall be a condition of employment for all employees to submit to drug testing under the following
circumstances;
*Random drug screens will be done on all health care professionals currently employed.

*When there is reasonable suspicion to believe that an employee is under the influence of alcohol
or illegal drugs. Reasonable suspicion includes a suspicion that is based on specific personal
observations such as an employee's manner, disposition, muscular movement, appearance,
behavior, speech or breath odor: information provided to management by an employee, by law
enforcement officials by a security service or by other persons believed to be reliable; or a
suspicion that is based on other surrounding circumstances.

*When employees are involved in on the job accidents where personal injury or damage to
company property occurs,

*As part of a follow-up program to treatment for alcohol or drug abuse.

Testing of Applicants for Designated Safety-Sensitive Positions

As part of Independent Nursing Services's employment screening process, any applicant to whom an
offer of employment is made must pass a test for controlled substances under the procedures described below. The
offer of employment is conditioned on a negative test result. Applicants will be informed of Independent Nursing
Services's drug testing policy in the employment application.

Testing of Employees in Designated Safety-Sensitive Positions

• Annual Testing

Employees in the position(s) of Patient Care will be required to submit to annual drug testing under the
procedures described below. All testing will be at random and scheduled by the Human-Resources Department. If
an employee refuses to cooperate with the administration of the drug test, the refusal will be handled in the same
manner as a positive test result.

• Reasonable Suspicion Testing

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 If an employee occupies a designated safety-sensitive position and their supervisor or manager has a
reasonable suspicion that the employee is working in an impaired condition or otherwise in violation of this
Guideline, the employee will be asked about any observed behavior and offered an opportunity to give a reasonable
explanation. If the employee is unable to explain the behavior, they will be requested to take a drug test in
accordance with the procedures outlined below.

If the employee refuses to cooperate with the administration of the drug test, the refusal will be handled
in the same manner as a positive test result.

• Acknowledgment and Consent

Any employee subject to testing under this policy will be asked to sign a form acknowledging the
procedures governing testing and consenting to (1) the collection of a urine sample for the purpose of determining
the presence of alcohol or drugs, and (2) the release to Independent Nursing Services of medical information
regarding the test results. Refusal to sign the agreement and consent form or to submit to the drug test will result in
the revocation of an applicant's job offer or will subject an employee to discipline up to and including termination.

• Confidentiality

All drug testing records will be treated as confidential.

The Cost of Mandatory drug screen is $29.75 due at orientation. The entire amount will be reimbursed to the
employee after 40 hours of work, which must be completed within the first 30 days of employment.

Attendance Policy

1. Frequent Cancellations or tardiness with less than a four- (4) hour notice will be issued a verbal warning.

2. If cancellations continue the discipline actions below apply

3. Frequent cancellations = more than 3 cancellations within 30 days

Tardiness = arriving more than (15) fifteen minutes late

NO CALL/NO SHOW WILL RESULT IN IMMEDIATE DISMISSAL

The steps in our progressive discipline procedure are:

Step # 1-Verbal Warning

Step # 2-Written Warning
Step # 3-Final warning
Step # 4-Dismissal

The Company will depart from these progressive discipline steps when we believe that the circumstances warrant it.
The Company will investigate each incident and determine, at its discretion, the appropriate discipline based on the
severity of the offense, the employee’s past record, and the penalties imposed for similar incidents on employees
with similar disciplinary records.

12
Client/Facility Employment Policy
I understand that as an employee of INS I may not actively seek employment with the clients of INS. If I wish to
seek employment with these clients I understand that there may be one hundred and twenty- (120) days waiting
period required or a placement fee charged to the client.

Employee Cancellations
If you must cancel a previously scheduled shift, do not call the client/facility. Notify the Independent Nursing
Services, Inc. office at least four (4) hours prior to the beginning of the shift to allow ample time for coverage.
Please make the call yourself; do not ask friends or relatives to call us on your behalf.
You are responsible for notifying the Independent Nursing Services, Inc., office regarding any scheduling
changes in order to insure accurate records. Failure to notify the Independent Nursing Services, Inc. office may
delay receipt of your paycheck.

Sent Home Policy

If you arrive at your assignment and are told you are not needed, DO NOT LEAVE! If there is confusion as to
whether or not you should be there, make no assumptions. Call Independent Nursing Services, Inc. at once. Your
calling immediately allows us the opportunity to determine where the lack of communication is. Most often you are
needed and the client/facility simply doesn't have you written on their schedule.

Fulfilling Job Requirements

If an employee does not fulfill the job requirements while at a facility/client, which results in the facility/client refusal to pay for
billed services, the employee will be compensated by being paid the prevailing minimum wage for those hours in question. If
the employee is sent home during any shift for not performing the job requirements or for any disciplinary reason, that employee
will be compensated by being paid the prevailing minimum wage for the hours in questions.

Dress Code
Depending upon the assignment, Independent Nursing Services, Inc. dress code will vary. Nevertheless, to
promote a professional health care staff image, Independent Nursing Services, Inc. staff is expected to adhere to
the following dress standards.

* Generally all employees are expected to maintain a clean, neat appearance and to wear a clean white
uniform or pantsuit, white hose or socks, and white closed heel and toe shoes. Specific assignments
at various sites may dictate use of clothing such as "scrubs" or smocks.

* Street clothes are not approved for an Agency assignment.

* Wear appropriate work place attire such as skirts, slacks, and shirts. Types of dress not allowed:

- Blue jeans
- Low cut or sundresses
- Sandals without stockings
- Sweat suits
- Hats

Name Badges/Picture ID
Name badges/picture ID is provided to all Independent Nursing Services Inc. employees. You must wear your
name badge/picture ID at all times when working with INS. Facility personnel must be able to identify you by

13
name, qualifications and employer. Should you lose or damage your name badge, call Independent Nursing
Services, Inc. for a replacement. ID badges must be returned upon termination of employment.

Return of Property
Employees are responsible for all property, materials, or written information issued to them or in their possession or
control. Employees must return all INS property and that of its clients immediately upon request or upon
termination of employment.
Where permitted by applicable laws, INS may withhold from the employee’s final paycheck the cost of any items
that are not returned when required. INS may also take all action deemed appropriate to recover or protect its
property and that of its clients.

Resignation
Resignation is a voluntary act initiated by the employee to terminate employment with INS. Although advance
notice is not required, INS requests at least two weeks’ written resignation notice from all employees.
Prior to an employee’s departure, an exit interview may be scheduled to discuss the reasons for resignation and the
effect of the resignation on benefits.
If an employee does not provide advance notice as requested, the employee will be considered ineligible for rehire.

Solicitation
In an effort to assure a productive and harmonious work environment, persons not employed by INS may not solicit
or distribute literature in the workplace at any time for any purpose.
INS recognizes that employees may have interests in events and organizations outside the workplace; however,
employees may not solicit or distribute literature concerning these activities during working time. (Working time
does not include lunch periods, work breaks, or any other periods in which employees are not on duty.)
Examples of impermissible forms of solicitation include:
1. The collection of money, goods, or gifts for community groups
2. The collection of money, goods, or gifts for charitable groups
3. The collection of money, goods, or gifts for religious groups
4. The circulation of petitions
5. The collection of money, goods, or gifts for political groups
6. The distribution of literature not approved by the employer
7. The sale of goods, service, or subscriptions outside the scope of official organization business.
In addition, the posting of written solicitations on company bulletin boards is restricted. These bulletin boards
display important information, and employees should consult them frequently for:
Affirmative action statement
Employee announcements
Internal Memoranda
Workers’ Compensation insurance information
If employees have a message of interest to the workplace, they may submit it to the Manager for approval. The
Branch Manager will post all approved messages.

14
EMPLOYEE ACKNOWLEDGMENT AND RECEIPT
I acknowledge receipt of the Independent Nursing Services, Inc. Employee Handbook. I agree to conform to the
rules and regulations of the company as set forth in the Handbook that is incorporated herein.

I have entered into my employment relationship with INS voluntarily and acknowledge that there is no specified
length of employment. Accordingly, either INS or I can terminate the relationship at will, with or without cause, at
any time.

All employment at Independent Nursing Services, Inc. is "at will."

At-will employment means that the Company can terminate your employment for any reason or no reason, with or
without cause, at any time, without any advance warning or notice, and without any right of review outside the
company, except as permitted by statute.

This Handbook replaces any prior policy statements, practices, and oral statements that the Company would employ
any employee on other than at-will bases. Nothing in this Handbook is intended or is to be construed as contrary to
the at-will nature of employment.

Furthermore, I acknowledge that this handbook is neither a contract of employment nor a legal document. I have
received the handbook, and I understand that it is my responsibility to read and comply with the policies contained
in this handbook and any revisions made to it.

I acknowledge that I am responsible for reviewing the Handbook and directing any questions I may have with
respect to such review with the Company's designated personal representative administering such Handbook. I
agree that any action or claim against the Company arising out of or in any way related to my employment or
termination of employment, including, but not limited to, claims arising under state or federal civil rights statures,
must be brought within 180 days of the event giving rise to the claim. I waive any limitation periods to the contrary.
I further understand that as a temporary assignment employee, work is available to me and it is my
responsibility to contact and schedule work with Independent Nursing Services, Inc.

_____________________________ ____________________________________
“INS” Representative/ Date Employee's Signature/Date

15
INDEPENDENT NURSING SERVICES, INC.
DRUG TESTING
INS may conduct drug testing of job applicants’ pre-employment and randomly thereafter. Should this company
consider you for employment, you may be contacted regarding the time and location of the pre-employment drug
test. Refusal to take the drug test or failing the drug test can disqualify you from further consideration for a
position.

AUTHORIZATION AND UNDERSTANDING

I certify that the information given herein is true and complete without qualification. I understand that INS may
investigate my work and personal history and verify all data given on this application, on related papers, and in
interviews, and I authorize INS to do the same. This inquiry may include information as to my character, general
reputation and personal characteristics, and I consent to the conduct of this inquiry and to the consideration of any
statements of references or former employers that are given in response to the inquiry. I authorize all individuals,
school and employers named therein, except as specifically limited on this application, to provide information
requested about me, and I release them from liability for damages in providing this information. I understand and
acknowledge that INS can terminate my employment if I have provided incomplete, inaccurate, untrue or
misleading information in this application or on any other document or form at any time during my employment.

If terminated, I authorize INS to use any information in its possession concerning me for reference purposes and/or
if legally required to furnish any information, including disclosure of information to any third party, future employer
or prospective employer, without receiving any prior notice, and I release INS from any liability in connection with
such use or disclosure.

In consideration of my employment, I agree to conform to the rules and regulations of INS and the directions of its
Supervisors. I understand and acknowledge that, if employed, unless my employment becomes subject to a
collective bargaining agreement, my employment and compensation will be at the will of INS and can be
terminated, with or without cause, and with or without notice, at anytime at the option of either INS or myself. I
further understand and agree that no manager, representative, agent or employee of INS, other than the President,
has now or has had in the past any authority to enter into any agreement for employment for any specified period of
time or to make any agreement which is contrary to or a modification of the above described employment
relationship, and that any such agreement which is contrary to or a modification of the above described employment
relationship, and that any such agreement or representation must be in writing and signed by both myself and the
President of INS in order to be effective.

I further understand that my employment is conditional until such time as the results of any pre-employment drug
testing, if any is required, are known. I also understand and acknowledge that, as a part of the hiring process and
throughout my employment, if hired, I may be required to submit to medical/physical examinations at the
employer’s discretion and expense.

EMPLOYEE ACKNOWLEDGMENT _______________________________________

DATED________________________

16
 HEPATITIS B VACCINE DECLINATION

I, ___________________________________________ understand that due to my occupational

exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis
B virus (HBV) infection.

I decline hepatitis B vaccination at this time. I understand that by declining the vaccine, I
continue to be at risk of acquiring hepatitis B, a serious disease.

If in the future I have an occupational exposure to blood or other potentially infections materials
and I want to be vaccinated with Hepatitis B vaccine, I will receive the vaccination series and I
will provide Independent Nursing Services, Inc. with documentation stating I have recceived the
Hepatitis B Vaccine which will be kept on record with Independent Nursing Services, Inc.

______________________________________________________________________________
Signature of employee Signature of employer or agent

Date:_______________________________

Fax completed form to (586) 771-4205 or e mail Dan@independentnursing.com

 HIPAA COMPLIANCE FORM
The Health Information Portability & Accountability Act of 1996 (also known as HIPAA) was
enacted to standardize electronic data exchange, patient privacy and security. The Department of
Health and Human Services published specific rules governing the privacy of personal healthcare
information designated to protect health information that identifies individual patients. These
standards aim at protecting all medical records held or disclosed by entities such as hospitals,
whether communicated verbally, on paper, electronically or on labels (e.g. urine cup).

Each facility must comply with these Privacy Rules effective immediately. It is a condition of
Independent Nursing Services, Inc. contract with each facility that it also complies with HIPAA
regulations. Failure to do so may result in penalties including termination of an assignment, fines
and imprisonment.

During the start of an assignment you will be provided with specific instructions on the use and
permitted disclosure of healthcare information. It is mandatory that you comply with facility
rules on the privacy of patient healthcare information.

You agree that:

• Patient authorization is required for release of information.
• Access to patient information is restricted to authorized personnel.
• You will abide by facility standards on the privacy and disclosure of healthcare
information as a condition of your employment with Independent Nursing Services, Inc.
• You will report any known breaches to a manager at the facility and to Independent
Nursing Services, Inc.
• You will not disclose any patient healthcare information except with the permission of
the facility.

I have read, understand and agree to comply with the guidelines and terms outlined above.

______________________________ ______________________________
Employee Signature Agency Representative

______________________________ ______________________________
Employee Name (print) Date
 Late Cancellation and “No Call- No Show” Payroll Deduction

Our clients trust Independent Nursing Services (“INS”) to provide dependable quality staff to their
facilities. They are counting on us! Late cancellations and “No Call - No Shows” seriously impact our
relationships with our facilities and can not be accepted without immediate consequences. Many facilities
charge us if this occurs. Because of this we must institute a universal late call in and “No Call No Show”
policy effective immediately.

In the event an employee cancels his or her shift within 2 hours of the scheduled assignment and is
owed for work previously completed, Independent Nursing will pay the employee 2 hours of pay at the
acceptable state minimum wage. It will be deducted immediately upon notification that a cancellation
incident occurred. .

In the event an employee is a “No Call - No Show” for any scheduled assignment The employee
will be reimbursed the state regulated minimum wage for all work completed in that work week.

If you must cancel please be sure to give at least 4 hours notice to assure that a replacement can be
found.

Your signature below implies that you understand this Agreement and agree to abide by it, and are
subject to the disciplinary actions noted above.

_____________________________________________________________________________
Employee Signature Date

_____________________________________________________________________________
Independent Nursing Services Representative Signature Date

Fax completed form to (586) 771-4205 or e mail Dan@independentnursing.com

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