Plainfield Lpn

Employee Acknowledgment

I certify that my entries are true and accurate.

I also certify that I have not sustained any injury while working for Preferred Home Health Care & Nursing Services on the above case. In exchange for my employment and continued employment, I agree not to, privately or through another health care agency, work for the above client for a period of ninety (90) days from the above-stated week-ending date without written consent of Preferred Home Health Care & Nursing Services. Should I breach this agreement, I agree to pay to Preferred Home Health Care

& Nursing Services damages in the amount of $10,000.00. I agree that any court action relating to or arising of my employment or the services I perform for clients shall be tried by a court sitting without a jury.