APPLICANT AGREEMENT

Please Initial Each Section Below:

  As an employee of BCMS Service Bureau Staffing Service (hereinafter referred to as “COMPANY”), I herby authorize COMPANY to represent me to their clients for the purpose of obtaining temporary assignments or regular employment.

  The agreement for representation between COMPANY and me requires that COMPANY administer all invoicing and payroll functions.  If COMPANY places me on a temporary assignment, COMPANY will bill the client and pay me for my services in accordance with COMPANY’S standard payroll cycle.  If applicant is placed in a direct hire position, COMPANY will charge a placement fee to the client. Applicant understands that applicant will never be billed for a fee.

  Applicant agrees not to approach a client to whom applicant is introduced by COMPANY for work or work directly for client in any capacity until eighteen months have elapsed after completion of applicant’s assignment.  If applicant is approached about a direct hire position, applicant will notify COMPANY coordinator immediately. COMPANY will work to negotiate and facilitate the hiring process to whatever extent you desire.

  Applicant agrees to notify COMPANY in writing within 48 hours of the last assignment if available for work.  Failure to do so may affect unemployment claims.

  In the event you may be asked to work a Temporary Assignment for COMPANY you will need to complete an I-9 Form and a W-4 Form in addition to the applicant packet. By completing this information, you are eligible for, but NOT guaranteed temporary or permanent employment. If you are interested only in permanent employment, please keep in mind that prior to being officially hired by any of our clients; you may be asked to work temporarily to make sure you are in agreement to the job and its responsibilities.

  Applicant understands that COMPANY has full discretion as to all referrals. COMPANY makes no representation, warranty, endorsement, promise or guarantee as to specific potential Employers, employment or employability of the Applicant. In additions,

______Applicant agrees that if at any time applicant makes claims for personal injuries, applicant will submit, upon written request, to examination by a physician or physicians of employer’s selection, at employer’s expense, as often as may be requested.

  Applicant agrees that COMPANY is not responsible for any liabilities or for any other disputes which may arise between Applicant and potential Employers.

  Applicant understands that driving on client business, whether in applicant’s or client’s vehicle, is prohibited without prior written consent of COMPANY.

  Applicants understand that if he/she is placed in a position through the COMPANY and is subsequently unhappy, COMPANY  will not be able to present that person for consideration by another physician until notice has been given to current Employer or current Employer notifies COMPANY of his/her knowledge that Employee is looking for work.

  Applicant releases, discharges and agrees to hold harmless BCMS COMPANY from any and all claims, actions, and demands that may exist or may accrue against Applicant for acts, omissions, performance or lack thereof with any employer to whom Applicant is referred by COMPANY.

  Applicant understands that failure to report to a temporary assignment on a timely basis or without proper notification of cancellation to COMPANY will be construed as a resignation from COMPANY.

 Have you ever been convicted of a felony, or received deferred adjudication? If so, when, where and disposition of offense?  ×_______________________________________

  The facts given in this application are true and complete.  I understand that individuals or corporations may be contacted to provide information relating to my prior employment, education, or character. I hereby authorize the release of any information relating to my prior employment, education or character to COMPANY. I agree that any misstatements (s) or omission (s) as to material facts will constitute ground s for dismissal for employment.

Signature                            Date

Print Name Rev. 11/15/06

Proprietary Information and Intellectual Property Agreement

In consideration of my employment and remuneration by Bexar County Medical Society, Staffing Division, (herein referred to as “COMPANY”), I agree to the following:

During my employment with COMPANY clients (hereinafter referred to as “CUSTOMER”), COMPANY confidential information may include health information that is protected under applicable state and/or federal law, including without limitation, protected health information (PHI”) as defined in the regulations at 45 C.F.R. Parts 160 and 164 (the “Privacy Standards”) promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  Accordingly, I agree that all information received by me, directly or indirectly during my employment by COMPANY and/or my working with CUSTOMER, shall be held in the strictest confidence by me. I shall not directly or indirectly disclose or use, except in regard to my employment with COMPANY and my assignment with CUSTOMER, any such information as may be disclosed or otherwise imparted to me, or as may be developed during the course of my employment through COMPANY, for so long as said information is not in the public domain (generally known).

            This obligation of confidentiality shall not apply to information which is, or later becomes, part of the public domain (generally known) (1) through no fault of mine, (2) which I can prove is already in my possession, or (3) which is lawfully disclosed to me by a third party who is not under any obligation of confidentiality to COMPANY, CUSTOMER or its designee with respect to the disclosed information.

            I further agree that all files, records, documents, drawings, specifications, or other written material, equipment/devices, and all other items relating to the business of COMPANY or CUSTOMER, whether prepared by me, with my assistance, or otherwise coming into my possession, control or knowledge, are and shall remain the exclusive property of COMPANY and CUSTOMER and shall not be removed from the premises of COMPANY and CUSTOMER under any circumstance except for furthering the business of COMPANY and CUSTOMER.  On my termination with COMPANY for any reason, I agree to promptly deliver to COMPANY all of the foregoing, which are in my possession or under my control.

            Any and all discoveries, inventions (including but not limited to improvements or modifications) or other works relating to the work I perform while on assignment, or suggested by matters disclosed in conjunction with my assignment, whether or not patentable, copyrightable or otherwise subject to registration or protection which are made or conceived by me, solely or jointly with others, are works made for hire and shall be the property of COMPANY, CUSTOMER or its designee.  I hereby agree to promptly provide COMPANY, CUSTOMER or its designee with a complete written disclosure of each invention, discovery, literary and/or other work. I further agree to sign necessary documents and give COMPANY, CUSTOMER or its designee all other reasonable assistance to perfect and maintain whatever rights COMPANY, CUSTOMER or its designee deem appropriate, without charge to COMPANY, CUSTOMER or its designee.

            I understand and agree that the foregoing provisions benefit both COMPANY and its designee, and that either COMPANY, designee or both shall have every right and remedy to enforce the terms of this Agreement.  I agree to defend, indemnify and hold COMPANY and CUSTOMER harmless from and against all losses, liabilities, damages, judgments, claims, expenses (including reasonable attorneys’ fees), and costs (collectively, “Damages”) relating to my act(s) or omission(s).

Signature_______________________________

Print Name______________________________

Date___________________________________

Rev. 11/22/06