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VETERAN NAME:EMPLOYEE NAME:TERMS AND CONDITIONSThe parties agree to follow the policies and procedures of NJ DoAS Veterans-Directed Home and CommunityBased Services Program (VD HCBS). The Employee and program Veteran and/or Representative agree to holdharmless, release and forever discharge NJ DoAS and Public Partnerships, LLC from any claims and/or damagesthat might arise out of any action or omissions by the Employee, Veteran/Employer, and/or Representative.The Employee acknowledges the following: I am an employee of the Veteran/Employer, and am not the employee of Public Partnerships or NJDOAS. This Agreement does not guarantee the Employee a specific number of hours of work, nor does it limitthe Veteran/Employer from hiring other employees under the NJ DOAS VD HCBS program. Information shared with the Employee by the Veteran/Employer or the NJ DOAS and affiliated agenciesregarding the Veteran/Employer receiving services shall be confidential. I agree to carry out assigned duties and responsibilities explained by the Veteran/Employer, as outlinedin the Veteran’s plan of care. I understand that I am expected to be dependable and report to work on time. I understand that I must be 18 years or older to work for the Veteran/Employer. I understand that Legally Responsible Individuals (Legal Guardian, Power of Attorney, Conservator, OrRepresentative Payee) may not be paid employees. I agree to call the Veteran/Employer with as much advanced notice as possible, if I am ill or unable toreport to work on time. I agree to give the Veteran/Employer two weeks written notice if I decide to terminate this employmentagreement. The Veteran/Employer shall set the conditions of employment, and termination of employment shall bethe prerogative of the Veteran/Employer. I understand that I will be subject to a record check against the NJ Central Registry. I authorize Public Partnerships to submit my information to HireRight for a state-wide criminalbackground check, if my Employer requests the record check. The fees for any criminal backgroundchecks will be charged against the Veteran’s plan of care. Results of the Criminal Background Check and NJ Central Registry record search will be madeavailable to the State Program Office (SPO), Public Partnerships, the program participant, and theemployee, upon request. I understand that I am not authorized to begin employment until my Veteran/Employer has received a"Good-to-Go” notification from Public Partnerships. The NJ DOAS VD HCBS work week is defined as Saturday – Friday. I understand that Public Partnerships will pay me on behalf of my Veteran/Employer on a biweeklybasis, following the submission of accurate and approved timesheets. Overtime is not permitted in the NJ VD-HCBS program. Neither the Veteran/Employer will notschedule the worker for more than 40 hours per week, nor will the Employee provide more than 40hours of reimbursable service in a work week. As such, if an employee chooses to work for more than40 hours, they will not be reimbursed for their service. The Employee may not provide more than 16 hours of continuous service, without at least a 4-hourbreak between shifts.NJ VD HCBS: Information and Attestation Form v1.0Page 6 of 8

VETERAN NAME:EMPLOYEE NAME: I understand that I must report possible neglect, abuse or misuse of funds or property immediately. TheEmployee may call the NJ DHS hotline at 1-800-832-9173. I understand that I will be covered by unemployment insurance. I understand that I may not submit timesheets if (1) the Veteran becomes ineligible for Services, (2) theEmployee performs unauthorized tasks or works more hours than are approved on the Veteran’s plan ofcare, or (3) the Employee begins work prior to receiving notice of “Good-to-Go” from PublicPartnerships. I understand that I will not be paid for services when the Veteran/Employer is hospitalized or for anyother services not specifically authorized on the Veteran’s plan of care. I understand that I must notify Public Partnerships if/when my address or personal information changesor if I wish to change my payment and tax withholding preferences.The Veteran/Employer and/or their Representative acknowledges the following: The Veteran/Employer will immediately dismiss the Employee if (1) they have been found to have beenplaced on a Provider Disqualification Registry or List maintained by either NJ DOAS or OIG, (2) havecommitted abuse, neglect, or misuse of funds or property of a Veteran/Employer receiving services, or(3) have committed fraud or violated the terms of this Agreement. I will notify Public Partnerships if I decide to terminate the employment of any of my employees. I understand that I must report possible neglect, abuse or misuse of funds or property immediately bycalling the NJ DHS hotline at 1-800-832-9173. I understand that the Employee is not authorized to begin employment until the results of anybackground check screening results have been received and approved, and I have received a “Good-toGo” notification from Public Partnerships. I understand that Public Partnerships will pay the Employee on my behalf on a biweekly basis,following the submission of accurate and approved timesheets. I understand that the Employee may not submit timesheets if (1) I become ineligible for Services, (2) theEmployee performs unauthorized tasks or works more hours than are approved on plan of care, or (3)the Employee begins work prior to receiving notice of “Good-to-Go” from Public Partnerships. I understand that the Employee will not be paid for services when I am hospitalized or for any otherservices not specifically authorized in the plan of care. I understand that payment to the Employee for providing services to me will be from federal and statefunds, and that any false timesheets I approve, false statements I make, documents I falsify, or myconcealment of a material fact may be prosecuted under applicable federal and/or state law.NJ VD HCBS: Information and Attestation Form v1.0Page 7 of 8

VETERAN NAME:EMPLOYEE NAME:ATTESTATIONBy signing below, I and my Veteran/Employer attest that we have read and understand all program rules andresponsibilities. I further attest by signing below, that I have filled out the Relationship Questionnaire to indicatemy relationship to my employer, and that Public Partnerships will use this information to properly withhold mytaxes. If any misrepresentation of information in the Relationship Questionnaire sections result in an underwithholding of tax, it is my responsibility to pay the under withheld tax.I understand I must sign and return this form as a condition of employment in this program. I further attest bysigning below, that I understand what is being requested of me, and I agree to abide by these terms andconditions. I further understand and agree that violation of any of the terms and/or conditions may result intermination of this agreement.The Veteran/Employer understands that it is their responsibility to properly execute the USCIS Form I‐9, asdefined in Instructions for Employment Eligibility Verification by the Department of Homeland Security. PublicPartnerships provides the Form I‐9 in the employment packets, and the Veteran/Employer retains the originalForm I‐9 and forwards a completed copy to Public Partnerships; which Public Partnerships will retain in theEmployee’s files.If I request the Direct Deposit payment selection, I authorize Public Partnerships to process payments owed tome for services authorized by NJ DOAS. Public Partnerships will deposit my payment directly into my bankaccount using Automated Clearing House (ACH) transaction. I recognize that if I fail to provide complete andaccurate information on this form, processing may be delayed or made impossible, or my electronic paymentsmay be erroneously made. I certify that I have read and agree to comply with Public Partnerships rules governingpayments and electronic transfers. I authorize Public Partnerships to withdraw from the designated account allamounts deposited electronically in error. If the designated account is closed or has an insufficient balance toallow withdrawal, then I authorize Public Partnerships to withhold any payment owed to me by PublicPartnerships until the erroneous deposited amounts are repaid. If I decide to change or revoke this authorization,I recognize that I must forward such notice to Public Partnerships.VETERAN/EMPLOYER NAMEVETERAN/EMPLOYER SIGNATUREDATEEMPLOYEE NAMEEMPLOYEE SIGNATURENJ VD HCBS: Information and Attestation Form v1.0DATEPage 8 of 8

The Central Registry of Offenders Against Individuals with Developmental DisabilitiesEmployee/Volunteer Consent for Employers to Check RegistryN.J.A.C. 10:44DState of New Jersey Department of Human Services Office of Program Integrity and AccountabilityPO Box 700 Trenton, NJ 08625Please Complete the Following Information:Employee/Volunteer Last Name: First Name:Other Last/First Names Used: (please list any/all names used, including maiden name, nicknames or other)Date of Birth:Last Four (4) Digits of Social Security Number:Agency/Facility Name:In accordance with N.J.S.A. 30:6D-73 et seq., I understand that providing my employer/prospective employer with theabove information is for the purpose of my employer/prospective employer conducting a check of my name/identityagainst the NJ Department of Human Services’ (DHS) Central Registry of Offenders Against Individuals withDevelopmental Disabilities (Central Registry) for the purpose of working/volunteering at an agency/facility/program,licensed, regulated or contracted with the Department of Human Services.I understand that while I am awaiting the results of the Central Registry check, I may not work unsupervised withindividuals with developmental disabilities and that I must be accompanied by a senior staff member or supervisor in anyactivities involving individuals with developmental disabilities.By signing this agreement, I attest that the information I have provided above is factual and correct, and I can beterminated from employment/volunteering for failure to provide accurate information.I further attest that I am currently not on the NJ DHS Central Registry of Offenders Against Individuals with DevelopmentalDisabilities. I understand that if my name appears on the Central Registry, I may not be employed or allowed to volunteerin a program licensed, contracted or funded, directly or indirectly, by the State of New Jersey to work with individuals withdevelopmental disabilities.I understand that also under N.J.S.A. 30:6D-73 et seq., in my capacity as an employee, caregiver or volunteer, in aprogram or facility licensed, regulated or contracted with DHS, or receiving state funding directly or indirectly, I amrequired to immediately report any/all allegations of abuse, neglect and/or exploitation against an individual with adevelopmental disability to the NJ Department of Human Services and that failure to do so, while having reasonablecause to believe such an act was committed, constitutes a disorderly persons offense. I understand that when makingsuch a report, in good faith, I am immune from any civil or criminal liability that might otherwise attach from the act ofmaking the report. I understand that in situations of discrimination or discharge from employment as a result of making areport in good faith, I may seek court relief for such actions.I further understand that I am required to cooperate with investigations conducted by DHS or its designee(s). I have readand understand the above and hereby give my consent for my name to be checked against the Department of HumanServices, Central Registry of Offenders Against Individuals with Developmental Disabilities.SignatureEmployee/Prospective Employee/Volunteer Name (please print)DateEmployer/Provider Agency Use OnlyThe above named individual has been checked against the Central Registry of Offenders Against Individuals withDevelopmental Disabilities in accordance with N.J.A.C. 10:44DListed on RegistryRegistry Check Performed By: Date:Yes NoThis document should be maintained in the employee’s personnel file. Do not return to DHS.

USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 10/31/2022 START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,during completion of this form. Employers are liable for errors in the completion of this form.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) anemployee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because thedocumentation presented has a future expiration date may also constitute illegal discrimination.Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no laterthan the first day of employment, but not before accepting a job offer.)Last Name (Family Name)Address (Street Number and Name)Date of Birth (mm/dd/yyyy)Middle InitialFirst Name (Given Name)Apt. NumberU.S. Social Security Number-Other Last Names Used (if any)StateCity or TownZIP CodeEmployee's Telephone NumberEmployee's E-mail Address-I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents inconnection with the completion of this form.I attest, under penalty of perjury, that I am (check one of the following boxes):1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident(Alien Registration Number/USCIS Number):4. An alien authorized to workuntil (expiration date, if applicable, mm/dd/yyyy):Some aliens may write "N/A" in the expiration date field. (See instructions)QR Code - Section 1Do Not Write In This SpaceAliens authorized to work must provide only one of the following document numbers to complete Form I-9:An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.1. Alien Registration Number/USCIS Number:OR2. Form I-94 Admission Number:OR3. Foreign Passport Number:Country of Issuance:Signature of EmployeeToday's Date (mm/dd/yyyy)Preparer and/or Translator Certification (check one):I did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1.(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct.Today's Date (mm/dd/yyyy)Signature of Preparer or TranslatorLast Name (Family Name)Address (Street Number and Name)First Name (Given Name)City or TownStateZIP CodeEmployer Completes Next PageForm I-9 10/21/2019Page 1 of 3

USCISForm I-9Employment Eligibility VerificationDepartment of Homeland SecurityU.S. Citizenship and Immigration ServicesOMB No. 1615-0047Expires 10/31/2022Section 2. Employer or Authorized Representative Review and Verification(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. Youmust physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Listsof Acceptable Documents.")Employee Info from Section 1Last Name (Family Name)List AM.I.First Name (Given Name)ORList BCitizenship/Immigration StatusANDList CIdentityIdentity and Employment AuthorizationEmployment AuthorizationDocument TitleDocument TitleDocument TitleIssuing AuthorityIssuing AuthorityIssuing AuthorityDocument NumberDocument NumberDocument NumberExpiration Date (if any) (mm/dd/yyyy)Expiration Date (if any) (mm/dd/yyyy)Expiration Date (if any) (mm/dd/yyyy)Document TitleQR Code - Sections 2 & 3Do Not Write In This SpaceAdditional InformationIssuing AuthorityDocument NumberExpiration Date (if any) (mm/dd/yyyy)Document TitleIssuing AuthorityDocument NumberExpiration Date (if any) (mm/dd/yyyy)Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge theemployee is authorized to work in the United States.The employee's first day of employment (mm/dd/yyyy):Signature of Employer or Authorized Representative(See instructions for exemptions)Today's Date (mm/dd/yyyy)Title of Employer or Authorized RepresentativeHousehold EmployerLast Name of Employer or Authorized RepresentativeFirst Name of Employer or Authorized RepresentativeEmployer's Business or Organization Address (Street Number and Name)City or TownEmployer's Business or Organization NameStateZIP CodeSection 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)A. New Name (if applicable)Last Name (Family Name)B. Date of Rehire (if applicable)First Name (Given Name)Middle InitialDate (mm/dd/yyyy)C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishescontinuing employment authorization in the space provided below.Document TitleDocument NumberExpiration Date (if any) (mm/dd/yyyy)I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and ifthe employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.Signature of Employer or Authorized RepresentativeForm I-9 10/21/2019Today's Date (mm/dd/yyyy)Name of Employer or Authorized RepresentativePage 2 of 3

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIREDEmployees may present one selection from List Aor a combination of one selection from List B and one selection from List C.LIST ADocuments that EstablishBoth Identity andEmployment Authorization1. U.S. Passport or U.S. Passport Card2. Permanent Resident Card or AlienRegistration Receipt Card (Form I-551)3. Foreign passport that contains atemporary I-551 stamp or temporaryI-551 printed notation on a machinereadable immigrant visa4. Employment Authorization Documentthat contains a photograph (FormI-766)5. For a nonimmigrant alien authorizedto work for a specific employerbecause of his or her status:a. Foreign passport; andb. Form I-94 or Form I-94A that hasthe following:(1) The same name as the passport;and(2) An endorsement of the alien'snonimmigrant status as long asthat period of endorsement hasnot yet expired and theproposed employment is not inconflict with any restrictions orlimitations identified on the form.6. Passport from the Federated Statesof Micronesia (FSM) or the Republicof the Marshall Islands (RMI) withForm I-94 or Form I-94A indicatingnonimmigrant admission under theCompact of Free Association Betweenthe United States and the FSM or RMILIST BLIST CDocuments that EstablishEmployment AuthorizationDocuments that EstablishIdentityORAND1. Driver's license or ID card issued by aState or outlying possession of theUnited States provided it contains aphotograph or information such asname, date of birth, gender, height, eyecolor, and address2. ID card issued by federal, state or localgovernment agencies or entities,provided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, and address3. School ID card with a photograph4. Voter's registration card5. U.S. Military card or draft record6. Military dependent's ID card7. U.S. Coast Guard Merchant MarinerCard8. Native American tribal document9. Driver's license issued by a Canadiangovernment authorityFor persons under age 18 who areunable to present a documentlisted above:1. A Social Security Account Numbercard, unless the card includes one ofthe following restrictions:(1) NOT VALID FOR EMPLOYMENT(2) VALID FOR WORK ONLY WITHINS AUTHORIZATION(3) VALID FOR WORK ONLY WITHDHS AUTHORIZATION2. Certification of report of birth issuedby the Department of State (FormsDS-1350, FS-545, FS-240)3. Original or certified copy of birthcertificate issued by a State,county, municipal authority, orterritory of the United Statesbearing an official seal4. Native American tribal document5. U.S. Citizen ID Card (Form I-197)6. Identification Card for Use ofResident Citizen in the UnitedStates (Form I-179)7. Employment authorizat

The standard method to submit an employee's time worked to Public Partnerships is electronically, using e-Timesheets on the BetterOnline web portal or through your smartphone using the Time4Care smartphone application. Submitting time worked through e-Timesheets or Time4Care allows the user to fill -out and submit timesheets