ADEMPAS

Week Ending Date

(Sunday)
8/31/14

TIME SHEET
INSTRUCTIONS: 1. Print neatly in CAPITAL LETTERS using black ink
2. Fax to 678-646-5401 OR 678-868-2331 Every Monday BY 10:00 a.m.

CLIENT INFORMATION
Name: DEBRA EPPARD
BRIGHTSTAR EMPLOYEE
Print Name: CONNIE McCOLLUM, RN
Report To: Last four digits of Social Security No.
6 1 9 0
Address: I certify that the days and times shown on this timesheet are correct
and were worked by me.
Signature:
Connie McCollum, RN
City, ST, Zip:
Phone:
CLIENT APPROVAL
The hours as shown above are correct (line through days and hours not used) and the work performed is satisfactory to the best knowledge of the client by signing this client approval.
We also acknowledge that we are bound by the terms of the BrightStar or such other master services agreement as may be in effect.
Conditions of engagement are set forth hereon.
Client: By: Title:




Shift
Start
Unpaid Breaks

Shift
End
Actual
Hours
Worked

S
u
p
v

I
n
i
t
i
a
l
s

Day

Date

Out

In

Out

In

Out

In

Out

In
MON

TUE

WED

THU

FRI
8/29 2P 4P 2H
SAT

SUN


Total:
2H
NOTE: It is the employees responsibility to notify their supervisor of any issues/conditions that require the employee to work beyond their regularly scheduled hours.
Thank you for your confidence in BRIGHTSTAR
For the services of our employee, whose name appears on the front of this copy under
"BRIGHTSTAR," we will invoice as verbally agreed.

The billing rate charged is determined on a basis of the amount of experience necessary for the
engagement and not the amount of experience of our employee. Should you wish to use our
employee for other engagements, please feel free to do so. The hourly billing rate may then
change to reflect the experience necessary to complete the engagement. Call your local
BrightStar office for any adjustment in the hourly billing rate.

Our employee is assigned to you under the following Conditions of Engagement
1) The person assigned is an employee of BRIGHTSTAR and shall not be deemed to be your
employee. BRIGHTSTAR warrants that its employee is adequately covered by workers' compensation
insurance and that it assumes total responsibility to pay all applicable federal, state and local
withholding taxes and unemployment taxes, as well as social security, state disability insurance and
all other payroll charges.

2) BRIGHTSTAR guarantees your satisfaction with our employee's services by extending to
you the following guarantee. If for any reason you are dissatisfied with a particular
individual provided by BRIGHTSTAR we will remove such person immediately and furnish a
replacement as soon as reasonably practicable. If you notify us of your dissatisfaction prior to the
conclusion of the individual's first day of work, BRIGHTSTAR will not charge you for the first
2 hours worked. This guarantee is in lieu of all other guarantees or warranties, express or implied.

3) Our employee will present a timesheet to you or your representative for verification and
initials on a daily basis and for a signature at the end of each week. Your signature thereon
indicates your acknowledgement of all of the Conditions of Engagement. You will be billed
weekly for the total hours worked. Because BRIGHTSTAR invoices reflect payroll we have
already paid, our invoices are DUE UPON RECEIPT.

4) Our employees represent our inventory of skilled professionals and in the event you wish
them converted to your employ or another employer to whom you refer them, you agree to
pay a conversion fee. The flat fee conversion calculation is 30% of the annual salary. The
same calculation will be used if you convert our employee on a part-time basis using the full-
time equivalent salary.
You also agree to pay a conversion fee if our employee assigned to you is hired by a subsidiary or
other related company or business as a result of your referral of our employee to that company.
The conversion fee is payable if you hire our employee assigned to you, regardless of the
employment classification, on either a permanent, temporary (including temporary engagements
through another agency) or consulting basis within twelve months after the later of (1) the date of
candidate's introduction or interview with your company, (2) the last day of the engagement, or (3)
the date of referral.

5) Supervision of a BRIGHTSTAR employee's work on your premises (or whenever you assign the
employee) is your responsibility.

The BRIGHTSTAR employee will work only under client's supervision. Client shall be solely
responsible to provide to BRIGHTSTAR employees such day-to-day guidance, assistance and
other information as is necessary for the successful and timely completion of the BRIGHTSTAR
employee's engagement.

6) A BRIGHTSTAR employee may not handle cash, negotiables or other valuables without the
written consent of BRIGHTSTAR and then only under your direct supervision. A BRIGHTSTAR
employee may not, under any circumstances, transport or convey monies, securities or any
negotiable instruments (including, but not limited to, delivering bank deposits to a bank or other
institution).

7) It is understood that under no circumstances will BRIGHTSTAR be responsible for claims for
work performed unless such claims are reported in writing to BRIGHTSTAR within thirty (30)
days after termination of the employee's engagement with you.

8) Each invoice will evidence a separate and distinct contract. Unless otherwise prohibited by the
law of the state where this engagement occurred, in the event that you fail to pay the
charges of BRIGHTSTAR, you will be responsible for all costs, including reasonable attorney's fees,
whether or not suit is initiated