AT HOME HOSPICE RECEIPT OF UNIFORM ACKNOWLEDGEMENT FORM by cuiliqing

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									                                     AT HOME HOSPICE

RECEIPT OF UNIFORM ACKNOWLEDGEMENT FORM & FINANCIAL OBLIGATION
                            FORM



Date: _____________________________________



I hereby acknowledge receipt and assignment of the following Company Property:



____COMPLETE UNIFORM SET

____SCRUB PANTS (QTY)

____SCRUB TOP (QTY)

____SCRUB JACKET (QTY)

____NAME BADGE



Return of Property and close of all financial obligations: In the event of termination of
employment, I will settle all open employee accounts (e.g., uniform balance, cash advances,
credit card liabilities, etc.) in full and return all company property (specified above or on an
attached sheet), upon my last day of work (or as specified by my supervisor). If any property is
not returned, I authorize a reasonable value for such items to be deducted from my final
paycheck (and if applicable and final reimbursement owed to me).




Employee Signature: __________________________________              Date: ___________________




Original Copy – Employee’s AHH Personnel File
Copy- Employee

								
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