I assert that the facts on this application are true and complete as far as I know, and I understand that data found to be false are grounds for dismissal if Palmetto Home Care Upstate (PHC) employs me.

I authorize PHC to investigate all statements contained herein, and I authorize all employers and references to give all pertinent information, personal or otherwise, and release involved parties from all liability from any damage that might come from using this information. (Use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws is not permitted.)

I understand and agree that any agreement for employment for any length of time must be in writing and signed by an authorized company representative.

Personal Care Assistants for Palmetto Home Care have varying duties depending on client needs, but their jobs can entail:

• Bathing
Assisting the client with bathing, whether by assistance into the shower or tub or by performing a bed bath.

• Personal Hygiene
Ensuring that the client has good personal hygiene by aiding them in tasks like mouth care, skin care, hair care, shaving, and shampooing

• Mobility
assisting the client with ambulation, to bed, or with turning.

• Nutrition
preparing meals for the client, serving those meals, and helping the client eat those meals.

• Toileting
Helping the client in use of the urinal/bedpan/commode or providing incontinence care.

• Light housekeeping
Cleaning the client's laundry, bedroom, and kitchen; washing the client's dishes; changing or making the client's bed; and vacuuming or sweeping of the client's lived-in area.

• Errands
Taking the client grocery shopping or to doctors' appointments.

• Companion Care
Conversing and discussing current events with the client.

Clients may receive other customized services upon request, so the above list is not intended to be comprehensive.

Remind clients to take medication.
The PCA can help organized medication.
The PCA can bring medication to the Client.
The PCA can help open the medication for the client but cannot administer medication to the client.

Never discuss the client or client's information with someone who is not apart of the healthcare team.
Do Not leave client information laying around or where others can see it.
If there is any suspected abuse report to your supervisor immediately.
Always respect a client wishes and choices regarding their healthcare.
Remember clients has the right to make all their decisions regarding their healthcare.

Please remember to wash the affected area with warm water.
Pat dry the area.
Apply ointment or antiseptic to the area.
Apply a band aid.
For cuts that are deep and burns that are severe, seek immediate medical assistance (call 911).
Wear Gloves at all times.

Speak slowly and clearly where the client can understand.
Give the client time to respond.
Reorient client to their surroundings if they become confused.
Always let the client know of the procedure you are going to perform before you do it.
Do tasks with or related to the client at the same time everyday.

Clock in and out per company policy.
Each visit document the client care per company policy.
Remember Not Charted means Not done!

This NON-SOLICITATION Agreement (the "Agreement") is entered into by Palmetto Home Care, Inc. ("Palmetto Home Care") with its principal offices at 25 Woods Lake Rd Suite 301 Greenville, SC 29607 and between, ("Employee") for the purpose of preventing any solicitation of Palmetto Home Care Clients (a "Client" being a person to whom Palmetto Home Care is providing services either through the Employee or any other employee of the company) by an Employee who decides to cease employment at Palmetto Home Care and work for another home care agency or the like.

1. NON-SOLICITATION OF CLIENTS: The Employee agrees that, without expressed written consent, at all times while Client Is employing the services of Palmetto Home Care and for twelve (12) months thereafter, the Employee will not, directly or indirectly, whether individually or as an officer, director, employee, consultant, partner, or in any other capacity whatsoever: solicit, divert, retain (including as a consultant) or encourage the Client to leave or terminate his/her services with Palmetto Home Care and/or provide services for the Client as an employee of another home care agency for a period of twelve (12) months after leaving the employ of Palmetto Home Care.

2. ACKNOWLEDGMENT: Employee agrees and acknowledges that its non-solicitation obligations hereunder are essential to the protection of Palmetto Home Care's business. Employee also agrees that damages associated with a breach of this non- solicitation agreement, while irreparable, are at least the value of the Client contract for a twelve-month period. Employee acknowledges that, if he/she violates this non-solicitation agreement, Employee is Ilable to Palmetto Home Care for, at a minimum, the value of the Client contract calculated out over a twelve month period. Palmetto Home Care reserves the right to seek legal action in the collection of these damages from Employee, including, but not limited to, the withholding of any pay due to Employee after the breach.

3. SEVERABILITY: The Employee and Palmetto Home Care acknowledge that this Agreement is reasonable, valid and enforceable. However, if a court of competent jurisdiction finds any of the provisions of this Agreement to be too broad to be enforceable, it is the parties' intent that such provision be reduced in scope by the court only to the extent deemed necessary by that court to render the provision reasonable and enforceable, bearing in mind that the intention of this Agreement is to give Palmetto Home Care the broadest possible protection against the solicitation of its Clients. In the event that any of the provisions of this Agreement will be held to be invalid or unenforceable in whole or in part, those provisions to the extent enforceable and all other provisions will nevertheless continue to be valid and enforceable as though the Invalid or unenforceable parts had not been included in this Agreement and the remaining provisions had been executed by both parties subsequent to the expungement of the invalid provision.

4. DISPUTES: Employee and Palmetto Home Care agree to make a good-faith effort to resolve any disagreement arising out of, or in connection with, this Agreement through negotiation. Should the parties fail to resolve any such disagreement within ten (10) days, any controversy or claim arising out of or relating to this Agreement, including, without limitation, the interpretation or breach thereof, shall be Subject to litigation in the Court of Common Pleas, Greenville County, South Carolina.

5. WAIVER: Neither party shall be deemed by mere lapse of time (without giving notice or taking other action hereunder) to have waived any breach by the other party of any of the provisions of this Agreement. Further, the waiver by either party of a particular breach of this Agreement by the other party shall not be construed as, or constitute, a continuing waiver of such breach, or of other breaches of the same or other provisions of this Agreement.

6. REMEDIES NOT EXCLUSIVE: The remedies available to the parties under this Agreement are cumulative and not exclusive to each other, and any such remedy will not be deemed or construed to affect any right which either of the parties is entitled to seek at law, in equity or by statute.

This Agreement and the performance hereof shall be construed and governed in accordance with the laws of the State of South Carolina. IN WITNESS WHEREOF, and intending to be legally bound hereby, the parties have caused this Non-Solicitation Agreement to be duly executed as an instrument under seal as of the date and year first written below.

As an employee of PHC, I will only work the allotted hours dictated by Medicaid. If I work over the allotted hours dictated by Medicaid, PHC will not be held responsible for payment for that time worked.

Medicaid will only reimburse up to the authorized hours allotted to a client. Any hours worked over the Medicaid allotted hours will not be paid, Only work the allotted hours for your particular client(s).

90 DAY PROBATION

I, understand by accepting employment with Palmetto Home Care Upstate, LLC, I will be working under a 90-day probationary period. I understand if I am absent from work for any reason within this 90 period, I can receive disciplinary action up to termination of employment.

At PHC we want to give our clients the best care possible, and being available for work is one of the most important steps to our clients receiving this care.

Thank you!
Management

Resolutions (Claims)

I, agree that I will have to wait till Community Long Term Care (CLTC) authorizes and accepts any resolutions that I may commit. It may take up to 2 months or more for resolutions to be paid. That means, you will not be paid for those resolutions until CLTC accepts them. Resolutions, meaning anytime I do not clock in, out or both. I also understand that CLTC has a 12 strike policy per calendar year and after 12 strikes, CLTC will not pay any claims (resolutions). That means, AFTER 12 STRIKES, YOU WILL NOT BE PAID FOR RESOLUTIONS YOU COMMIT.

Time Sheets Due (DDSN & PRIVATE PAY CLIENTS ONLY)

I, have been informed that Time Sheets are due in the office every other Monday by 3:00 P.M. Time sheets can no longer be slide under the door or put in the mailbox. You must bring them in the office. If you do not have your Time Sheets filled out correctly (Dates, Times, and Total Hours) we will not enter the time. If we do not have your time sheets by 3pm on Monday you will not be paid for the hours until the next payroll, Or a $25.00 processing fee can be deducted to process payroll timely If payroll turned in before 12pm Tuesday.

Thank you.

TWO WEEK NOTICE TO WORK WITH CLIENT OR OFFICE

I understand that if do not complete my two-week notice, my final check hourly rate will be reduced to minimum wage of $7.25 per hr. When assigned to a certain client, if you decide you want to change clients, you must give a two week notice before changing the schedule.

Consent to Background Check

I undersigned, hereby give Palmetto Home Care Upstate, LLC, ("PHCU") permission to run a background check for purposes of employment with the company. This permission continues during my performance of work for or on behalf of PHCU and maybe withdrawn at any time.

For the purpose of checking my background, I provide the following information and declare that it is true and accurate. (Please print)

Information obtained as a result of this background check will be treated as confidential.

I SO CONSENT

Terms of Employment Notice

ANNUAL IN-SERVICE DOCUMENTATION
(for Personal Care Aides participating in CLTC programs)

My name below certifies that the above listed trainings have occurred under my supervision.

It is hereby certified that the competency evaluation documented by this form meets the requirements of the competency training and evaluation program as outlined in the Community Long Term Care Scope of Services for Personal Care Aide and was administered by an instructor/evaluator who meets the requirements of such regulations.

In 1988, Congress enacted the Drug Free Workplace Act to require federal contractors to establish and maintain a work environment that is free from the effects of drug use and abuse. Federal Regulations 49 CFR Part 40 (§382) present the general terms of this program and its guidelines We agree with that goal and believe that Palmetto Home Care Upstate, LLC has responsibility to its employees and those who use or come in contact with its products/services, to ensure a safe and productive work environment. To satisfy these responsibilities, it is the policy of Palmetto Home Care Upstate, LLC and a condition of employment that an employee be present and able to perform their job free from the effects of alcohol, narcotics, depressants, stimulants, hallucinogens and cannabis or any other substances, which can impair job performance.

Our Commitment

We recognize that drug and alcohol abuse may be a sign of chemical dependency and that substance abuse can be successfully treated with professional help.

Palmetto Home Care Upstate, LLC

Provides an Employee Assistance Program (EAP) through SapList.Com for employees to deal with substance abuse and other personal problems that can affect work performance. Our commitment is to help employees remain productive members of our team. In certain circumstances, the company may insist upon a mandatory referral to our EAP as a condition of continued employment No employee will be disciplined or discriminated against simply for seeking help.

Employee Responsibility

The employee is responsible for following all of our work and safety rules, and for observing the standards of behavior and employer, co-workers, and customers have the right to expect from you. In addition, if you believe you may have a problem with drugs or alcohol, you are responsible for seeking assistance, whether from or through the company or any other resource, before a drug or alcohol problem adversely affects your work performance or results in a violation of this policy. The time to seek help is BEFORE you are in "trouble", NOT AFTER. If a professional assessment is made that you have a problem with Drugs or Alcohol, your continued employment may be conditioned upon:

• Entering into and completing a treatment program approved by the company.
• Signing and living up to a last chance performance agreement.
• Undergoing a Follow-up Testing Program at companies' discretion.

Scope of Our Policy

This Policy and each of its rules apply whenever an employee is on or in Company Property, surrounding grounds and parking lots, leased or rented space, Company time (including breaks and meal periods), in any vehicle used on Company business, and in other circumstances (such as on customer premises or at business/sales functions) we believe may adversely affect our operations, safety, reputation or the administration of this policy.

Our Drug and Alcohol Rules

The following rules are extremely important and an employee who violates any one of them will be subject to disciplinary action, up to and including termination.

1. Alcohol An employee may not possess, use, transfer, offer, or be under the influence of any intoxicating liquor while at work or on company business. This rule prohibits using any alcohol prior to reporting to work, during breaks or meal periods, or in conjunction with any Company activity, except social or business events where a Corporate Officer has authorized the moderate consumption of Alcoholic Beverages.

2. An employee will be removed from a Safety Sensitive Position for 24 hours if your BA is more than .02 and less than .04. A Breath Test over .04 is a DOT Violation, and a referral will be required to a Substance Abuse Professional before being released back to a safety sensitive position.

3. Drugs An Employee may not possess, use, transfer, offer, share, attempt to sell or obtain, manufacture, or be under the influence of any drug or similar substance and may not have any drugs of similar substances present in the body. Thus, an employee who tests positive for any illegal drug violates this rule. This rule also pertains to Prescription drugs being taken without doctor's authorization.

4. Drug Paraphernalia and Alcohol Containers An Employee may not possess any Drug Paraphernalia or Alcohol Containers.

5. Prescriptions/Over—the-counter Medications It is the employee's responsibility to check the potential effects of prescribed drugs and over-the counter Medications with your doctor or pharmacists before starting work, and to immediately let your supervisor know when such use makes it unsafe for you to report to work or do your job.

6. Adulterants any substance that is used for the purpose of manipulating a drug test by adding to the specimen or ingesting.

Pre-Employment Testing

All employees are required to pass a pre-employment urine drug test before being hired.

Random Drug Testing

The company reserves the right to randomly drug test at any time. Random drug testing is implemented at the company's discretion and the employee must come in the same day to continue employment.

Mandatory Post Accident Testing

Post-accident drug and/or alcohol testing will be at supervisor or company request, or as Defined in 49 CFR Part 40. see Chart

Reasonable Suspicion Testing or Reasonable Cause

At least one Supervisor will be trained in accordance to 49 CFR 382.603 of the Federal Register to make these observations of Work Performance, Behavior, and Physical Indicators.

• Observable Symptoms or Unusual Behavior.
• The Odor or Smell of Alcohol or Drugs on the employee's breath or clothes or in an area (such as in a vehicle, office, work area, or restroom) immediately controlled or occupied by the employee.
• Alcohol, alcohol containers, illegal drugs or drug paraphernalia in the employee's possession or in an area controlled or occupied by the employee (vehicle, office, desk restroom.)
• Unexplained or Significant deterioration in job performance.
• Unexplained significant changes in behavior (e.g., abusive behavior, repeated disregard of safety rules or procedures, insubordination. etc.);
• Evidence that the employee may have tampered with a previous drug test.
• Criminal citations, arrests or convictions involving drugs and alcohol.
• Unexplained absenteeism or tardiness
• Employee admissions regarding drug or alcohol use.
• Any involvement in any work-related accident or near misses.
• Any type of Paraphernalia discovered on your person or Company Property

Fit for Duty

The company could require a fit for duty exam by a certified Medical Practitioner; this exam can be administered along with Drug and Alcohol Screen to determine if employee is fit for Duty. This could be requested in addition to the DOT Medical card Certificate.

Duty to Cooperate

An employee who fails to cooperate in the administration of this policy generally will be terminated and is in violation of §49 CFR Part 40. This includes such things as:

• Refusing to consent to testing, to submit a sample, or to sign required forms.
• Refusing to cooperate in any way (for example, refusing to courteously and candidly cooperate in any interview or investigation, including any form of truthfulness, misrepresentation or misleading statements or omissions.);
• Any form of dishonesty in the investigation or testing process.
• Refusing to test again at a time of the Company's choosing whenever any test results in a finding of a dilute sample or reasonable suspicion.
• Failure to accept the referral, to enter into and complete an approved treatment program, or to sign or adhere to the commitments in the Last Chance Performance Agreement.

1. I, acknowledge receiving a copy of the Company's Drug and Alcohol Policy. Date
2. I voluntarily agree to provide a sample of my Urine for Testing and to submit to any related physical or other examination when I have been requested to do so.
3. I authorize the release of the Test Result (and any other relevant medical information) to the Company for its use evaluation and suitability for continued employment. I also release the Company from all liability arising out of or connected with the testing.
4. I understand that if I refuse to submit to the testing, to give a requested sample(s), to authorize release of the results to the company, and/or if the test results indicate that I do not meet the Company's standards, I may be terminated.
5. I understand that any attempt to switch, adulterate or in any way tamper with the requested sample(s) or to otherwise manipulate the testing process will result in termination of employment. I also understand that if my test results are dilute on the second testing, I may be terminated.