NEW EMPLOYEE PACKET - SHORE UP!

1 NEW EMPLOYEE PACKET CRIMINAL BACKGROUND DECLARATION I I, _____, declare that I have not been convicted of a criminal offense, nor am I the subject of pending charges for any felony, theft, crime of violence or moral turpitude. I agree to have a criminal background investigation conducted by the Maryland State Police. I understand that if the investigation reveals any criminal offense conviction or pending charges, it is grounds for my employment with SHORE UP! Inc. to be terminated. _____ EMPLOYEE s Signature _____ Date Sworn and subscribed to before me this _____ day of _____ 20_____ _____ Notary Public ADDITIONAL INFORMATION AUTHORIZATION FOR AUTOMATED DEPOSITS (Direct Deposit) COMPANY NAME: SHORE UP! Inc. COMPANY ID NUMBER: 52 0886996 I (we) hereby authorize SHORE UP! INC_ , hereinafter called COMPANY, to initiate credit entries and to initiate, IF NECESSARY, DEBIT AND ADJUSTMENTS FOR ANY CREDIT ENTRIES IN ERROR to my (our) checking [ ] savings [ ] account (select one) indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

2 DEPOSITORY NAME BRANCH CITY STATE ZIP ROUTING/ABA # ACCOUNT # This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY a reasonable opportunity to act on it. NAME(S) ID NUMBER SIGNATURE Please attach a voided check if a checking account is selecte d. DATE FOR COMPANY USE ONLY Date Received Processed By Form #618 Helping People. Changing FREE WORKPLACE REGULATIONSF reddyL. MitchellExecutiveDirectorThe Drug-Free Workplace Act, enacted November 18, 1988 requires certain employerswho receive funds from the federal government to comply with regulations aimed atreducing the impact of drugs on the workplace. In accordance with this Act (Public Law100-690) the following drug-free policy statements are immediately are expected andrequiredto report for work ontime and inappropriate mental and physical condition for is the intent ofSHORE UP!

3 Inc. to maintain a drug-free, healthful, safe, and secure unlawful manufacture, distribution,dispensation, possession or use ofcontrolled substances on agency premises, or while conducting agencybusiness off company premises, is absolutely prohibited. Violations of thispolicy will result in disciplinary action, up to and including termination,andmay have legal UP! Inc. also recognizes drug dependency as an illness and a majorhealth, safety, and security needing help in dealingwith such problems are encouraged to seek assistance through use ofcommunity resources, EMPLOYEE assistance programs or through ourhealth insurance plan, as a conditionof employment,an EMPLOYEE must abide by the terms of theabove policy and isrequired to notify SHORE UP!

4 Inc. PersonnelManagement of any criminal drug status conviction for a violationoccurring on or off agency premises while conducting agency businesswithin five (5) days after the 's SignatureDateSelf HelpOnRural Economicsand Urban Problems520 Snow Hill Road, Salisbury, MD 21804-6031 Phone410-749-1142 TDD (For The Deaf) People, Changing ETHICS POLICY(Standard Clause)Freddy DirectorAs a condition of employment,all employees of SHORE UP! Inc. or its affiliates,whose job classification is Management Level or above, are required to sign thiscertificate indicating their understanding and acceptance of these standardclauses relating to their The EMPLOYEE will neither offer, nor promise his or her services for hire toany public or private agency, organization, institution,company, group orindividual during the period of employment without prior notice to, andprior approval of the Executive Director of SHORE UP!

5 Inc. This does notpreclude negotiations with another organization for the purpose ofobtaining another regular full-time or part-time job in the place of theSHORE UP!, Inc. position. However, this provision does prohibit the useof the EMPLOYEE 's name, either orally or in writing, by or for anotherorganization seeking to obtain some advantage, such as a contract,through the use of the EMPLOYEE 's name, unless the Executive Directorapproves such a procedure in The EMPLOYEE will not perform professional services or consultation forany other organizations or governmental entity for payor pro bono (forpublic good) without written approval of the Executive The EMPLOYEE will neither disclose,discuss,nor make available thecontents of any materials (proposals, policies, training materials, etc.)

6 Developed by or for SHORE UP!, Inc., for its own use or for its clients use,to representatives of any other organization (besides the organization forwhich the material was developed) for a period covering the EMPLOYEE 'semploymentwith SHORE UP I, Inc. and the succeeding twelve work products developed by the EMPLOYEE for SHORE UP!, Inc. or itsclients are the property of SHORE UP! The EMPLOYEE , in accepting the position, releases SHORE UP! Inc. andits affiliates to use any photographs of the EMPLOYEE taken in the courseof work for educationalor accept these provisions of employment and understand that violations of theabove may result in action up to and including terminationof employment,orthat SHORE UP! Inc. may seek other legal or equitable remedies as it : EMPLOYEE 's signatureDate:_Self HelpOnRuralEconomics and UrbanProblems520 SnowHillRoad, Salisbury,MD 21804-6031 Phone 410-749-1142 TDD(For The Deaf) 410-742-9191 SHORT TERM DISABILITY is afforded to every full time EMPLOYEE that works at least 30 hours per week.

7 When initial enrollment forms are completed, this insurance coverage takes effect after sixty (60) days of employment at SHORE UP! Inc. There is no cost to the EMPLOYEE for this insurance. Employees should contact the personnel office if any changes need to be made to your policy. The short term disability insurance covers 60% of your weekly gross income for a period of thirteen weeks, if the EMPLOYEE does not have sick leave available to cover him/her during illness. When, or if, the EMPLOYEE has less than 15 days of sick .leave available through SHORE UP!, they are encouraged to contact personnel management to begin the process of applying for short term disability payments. Employees should be aware that benefit payments become effective on the eighth (8th) consecutive day of disability due to accident or sickness. All payments come directly from the insurance company, and employees are advised when checks are received by SHORE UP!

8 Inc. The EMPLOYEE basic life benefit amount for group term life insurance is 1 times your annual salary for employees under age 65. ~111 UnitedHealthcar~ Benefits'ENROLLMENT FORM- Group Life and DisabilityGroup Life and DisabilityInsurance products provided by UnimericaInsurance Companyor UnitedHealthcare Insurance CompanyUse this form to apply for or to make changes to the applicablecoverages listed applicants are subject to Evidence following information is required to accuratelyenroll you andyour dependents in the applicable coverage(s) will delayenrollment , including zip codeSocial Security NumberGenderDate of birthHire date (not needed if initial new case enrollment)Class (if applicable)Subgroup (if applicable)Annualsalary (required for salarybased benefits)Tobacco use (if benefits/ratesare based onnon-tobacco,tobaccouse)Supplemental Benefits.

9 Amount of current coverageAmount of new coverage requestedTotalamount of coverage after adding current and newcoverage amountsDependent Benefits:Dependent name andrelationship to EmployeeDependent date of birthGenderHandicapped information (if applicable)Student information (full-time, part-time, date or enrollmentand name of each school) INFORMATIONoEnrolloCanceloAddress Change0 Name ChangeoOtherDateLast Name CodeoSingle0 MarriedHome PhoneWorkPhoneAnnual Salary()()Employeror Group NameDivision/LocationSubgroup CodeJobTitleIf applicable, have youoryour dependent{s) usedtobaccoofany kindduring the last twelvemonths?DYes0 Noll ,UHIC Facets EnrollmentForm(4/09)~ UnitedHealthcar~eSpecialtyBeneftts'B. PRODUCT SELECTION - Application for (check all that apply): EMPLOYEE Hire Date:_Basic Life and AD&D Insurance:oBasic LifeInsurance0 Basic Accidental Death and Dismemberment (AD&D) EMPLOYEE Supplemental Life and AD&D Insurance:Increases may be subjectto Evidence of InsurabilityoEmployee Supplemental Life:0 EMPLOYEE Supplemental AD&D:Current Amount of Coverage:$Current Amount of Coverage:$_oIncrease coverage by:$0 Increase coverage by:$,_oDecrease coverage by:$0 Decrease coverage by:$_Total Amount of Coverage:$Total Amount of Coverage:$_BeneficiaryDesignation:Benefi ciary information should be maintained by the Employer on a separate Beneficiary Dependent Life and AD&D Insurance:oBasic Dependent Life Spouse:$amountoBasic Dependent Life Child(ren).}

10 $,amountoBasic Dependent AD&D Spouse:$amountoBasic Dependent AD&D Child(ren):$amountDependent Supplemental Life and AD&D Insurance:Increases may be subjectto Evidence ofInsurabilityoDependent Spouse Supplemental Life:0 Dependent Spouse AD&D:Current Amount of Coverage:$Current Amount of Coverage:$,_oIncrease coverage by:$0 Increase coverage by:$,_oDecrease coverage by:$0 Decrease coverage by:$_Total Amount of Coverage:$Total Amount of Coverage:$_oDependent Child Supplemental Life:Current Amount of Coverage:$,_oIncrease coverage by:$_oDecrease coverage by:$_Total Amount of Coverage:$_Disability Insurance:oShort Term Disability (STD)oDependent Child AD&D:Current Amount of Coverage:$,_oIncrease coverage by:$_oDecrease coverage by:$_Total Amount of Coverage:$_oLong Term Disability (LTD) FOR DEPENDENT COVERAGE (List all family members to be covered)If child is over age 1g, pleaseLast nameFirst of BirthRelationshipindicate status and/or schoolGenderCheck one0 Handicapped0 MoEnrolloWaive0 Student at0 FoCancel 0 Change0 Handicapped0 MoEnrolloWaive0 Student at0 FoCancel 0 Change0 Handicapped0 MoEnrolloWaive0 Student at0 FoCanceloChange0 Handicapped0 MoEnrolloWaive0 Student at0 FoCancel 0 ChangeoInitial enrollment following Date of HireoLate ApplicantEmployee Effective Date(mm/dd/yyyy)Signed for Employer byGroup Number100-8652 Ule, UHIC Facets Enrollment Form (4/09)Beneficiary FormGroup Term Life InsuranceUnitedHealthcare"dillA UnitedHeaitilGwqJCOmi'x"!