Job Officer Application Form

Job Officer Application Form and Engagement Agreement

Recitals

WHEREAS, Employer Name: is engaged in operations requiring a Job Officer to perform duties described below; and

WHEREAS, Applicant Name: submits this application and, if selected, agrees to be engaged under the terms set forth in this document; and

WHEREAS, the parties desire to set forth the scope, payment, term, confidentiality and other terms applicable to any engagement of Applicant as Job Officer.

Applicant Information

Full-time Part-time Contractor

Scope of Work

The Applicant, if engaged as Job Officer, shall perform duties including but not limited to recruitment coordination, job placement oversight, case management, employer relations, reporting and compliance monitoring as requested by Employer. Specific responsibilities and deliverables will be described below and may be amended in writing by mutual agreement.

Payment Terms

Employer shall pay Applicant compensation in accordance with the terms below. Compensation shall be due upon issuance of an invoice that complies with Employer's invoicing requirements and subject to applicable withholding if the engagement is employee-based.

Term and Termination

The engagement shall commence on Start Date: and shall continue until End Date: unless earlier terminated as provided herein.

Either party may terminate this engagement without cause upon written notice of Notice Period (days): . Employer may terminate immediately for cause upon a material breach by Applicant, including breach of confidentiality or fraud.

Confidentiality

Applicant acknowledges that during the course of the engagement Applicant may receive Confidential Information (as defined below). Applicant agrees to hold all Confidential Information in strict confidence, not to disclose it to third parties, and not to use it except as necessary to perform the Scope of Work. "Confidential Information" includes non-public business, financial, participant and program information, trade secrets, and other proprietary information disclosed orally, in writing, or by inspection.

Exceptions: Confidential Information does not include information that is (a) publicly available other than by a breach of this Agreement, (b) already in Applicant's lawful possession prior to disclosure without obligation of confidentiality, or (c) rightfully obtained by Applicant from a third party without restriction.

Applicant acknowledgement: By checking this box Applicant acknowledges agreement to and understanding of the Confidentiality obligations set forth above.

Representations; Background and Compliance

Applicant represents and warrants that all information provided in this application is true, complete and accurate. Applicant authorizes Employer to verify employment history and references and to conduct background checks to the extent permitted by law. Applicant shall comply with all applicable laws, regulations and Employer policies while performing duties under any engagement.

Have you ever been convicted of a felony? Yes No

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of Governing Law: without regard to its conflicts of law principles.

Entire Agreement

This document, together with any written appendices or schedules executed by both parties, constitutes the entire agreement between Employer and Applicant relating to the subject matter hereof and supersedes all prior negotiations, understandings and agreements, whether written or oral. Any amendment must be in writing and signed by both parties.

Applicant Certification and Authorization

By signing below Applicant certifies under penalty of perjury that the information supplied in this application is true and complete. Applicant authorizes Employer and its agents to make inquiries regarding Applicant's background, employment history and references and to obtain any necessary consents required by law for such inquiries.

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