2021

550 7th Ave, 21st Floor

New York, NY 10018
212-687-7200 (Phone)
212-697-9689 (Fax)

Employee Responsible for Completing ALL Applicable Area Additional Terms and Conditions

COMPANY NAME WEEK ENDING SUNDAY Recognizing that FORUM has incurred and will incur
substantial expense in connection with furnishing the
ADDRESS CITY services of the temporary employee hereof (“Employee”),
the company hereof (“Company”) agrees not to hire or
utilize the services of Employee directly or indirectly in any
JOB TITLE capacity whatsoever for a period of one (1) year after the
completion of Employee's assignment with Company
EMPLOYEE MUST FILL IN BELOW without paying FORUM a fee. If Employee is hired on a
MAIL MY CHECK DIRECT DEPOSIT SOCIAL SECURITY NO. (LAST 4 DIGITS) permanent basis, the fee shall be calculated in accordance
EMPLOYEE: I CERTIFY THAT HOURS SHOWN HEREIN REPRESENT THE with the schedule of FORUM’S placement fees then in
TOTAL HOURS WORKED THIS WEEK BY ME AND WERE PROPERLY VERIFIED
BY THE CLIENT. effect. If Employee is retained on a temporary basis, the
EMPLOYEE NAME original billing arrangement between FORUM and Company
shall apply, unless otherwise mutually agreed. Company
agrees to notify FORUM before making any arrangement to
EMPLOYEE SIGNATURE
utilize the services of Employee.

COMPANY: THE SIGNATURE BELOW REPRESENTS THAT YOU ARE IN AGREEMENT WITH ALL THE TERMS AND CONDITIONS BELOW HEREOF The person signing hereof is authorized to sign for Company
AND THAT THE HOURS SHOWN ARE CORRECT AND THE WORK WAS COMPLETED SATISFACTORILY. and agrees to the following on behalf of Company.
AUTHORIZED SIGNATURE TITLE
1. Company will not entrust Employee with unattended
premises, cash or negotiable securities, or authorize
PLEASE PRINT NAME SIGNED ABOVE IS THIS EMPLOYEE YES
CONTINUING THIS Employee to operate machinery or motor vehicles without
ASSIGNMENT? NO the prior written permission of FORUM in each instance, and
will indemnify and hold FORUM harmless from any claim
arising out of a breach of the foregoing;

DAY DATE HOURS TO NEAREST QUARTER HOUR 2. FORUM shall not be liable for any act or omission of
STARTED FINISHED (LUNCH) REG HOURS OVERTIME HRS Employee unless such act or omission is reported in writing
MON to FORUM within thirty (30) days after its occurrence;
TUES
3. Company will hold FORUM harmless from and indemnify
WED
against any claims for injury sustained by Employee on any
THU
premises owned, managed or controlled by Company
FRI whether arising under the Occupational Safety and Health
SAT Act or otherwise, and any and all claims, liabilities or costs,
SUN including reasonable attorney fees and disbursements
arising out of any act or failure to act on the part of Client,
DEPT. NAME AND / OR NUMBER REGULAR OVERTIME its employees or agents; and
HOURS MIN HOURS MIN

> <
TOTAL HOURS TO NEAREAST QUARTER HOUR
MINIMUM FOUR (4) HOURS PER EMPLOYEE PER DAY
4. If FORUM'S invoices are not paid when due, Company
agrees to pay a late charge of 1 1/2% of the unpaid balance
TOTAL
HOURS > per month. Company also agrees to pay reasonable legal
fees incurred in collecting a balance due.

FORUM guarantees satisfaction with Employee by providing an 8-hour guarantee. If for any reason Company is dissatisfied with Employee, FORUM will waive
its fee for the first 8 hours worked by Employee, provided FORUM is given the opportunity to replace Employee. Company agrees that Employee is
satisfactory unless it advises FORUM to the contrary before the end of the first 8 hours of Employee's work for Company.