ACKNOWLEDGEMENTS AND SIGNATURE Sample Clauses

ACKNOWLEDGEMENTS AND SIGNATURE. Applicant must check all boxes, sign, and date. ☐ I affirm that the information I have provided on this form is complete and accurate to the best of my knowledge. ☐ I authorize DHS IRIS partner agencies to conduct a background check now and to automatically conduct future background checks – without notice – every 4 years and ad hoc for as long as I provide paid IRIS services. ☐ I understand that an out-of-state or out-of-country background check may increase processing time. SIGNATURE – Applicant Date Signed Division of Medicaid Services F-01201C (02/2017) IRIS PARTICIPANT EMPLOYER / PARTICIPANT- HIRED WORKER AGREEMENT INSTRUCTIONS: Completion of this form is not required through Wisconsin State Statute; however, completion of this form is an IRIS Program requirement. Both the participant-hired worker and the participant employer must sign and date the bottom in order to be considered complete. Participant-hired worker may not begin working for participant employer until they have received a mailed start date letter. Personally identifiable information on this form is collected to verify that the application is complete, and will be used only for this purpose. Completed forms should be submitted to the participant’s Fiscal Employer Agent. Name – Participant-Hired Worker (Last, First) Name – Participant Employer (Last, First) Date of Birth – Participant-Hired Worker The participant employer requires the following tasks and duties to be performed by the participant-hired worker: The participant employer agrees to provide/arrange for worker training as described below: Participant-Hired Worker Schedule – Indicate Day(s) of the Week Participant-Hired Worker Will Provide Service(s) Service Sunday Monday Tuesday Wednesday Thursday Friday Saturday Supportive Home Care (SHC) Self-Directed Personal Care (SDPC) Respite Care (R) Other Mileage If “Other”, please explain: Participant-Hired Worker Services – Indicate Which Service(s), Pay Rate(s), Unit Type(s) and Units Per Week the Participant-Hired Worker will Provide Service Pay Rate Unit Type (per hour, per day, etc.) Units/Week Supportive Home Care (SHC) Self-Directed Personal Care (SDPC) Respite Care (R) Other Mileage Indicate the rate and the number of miles per month the participant-hired worker is authorized to provide. If “Other”, please explain: BY SIGNING BELOW: I (We) understand that the services are provided under Medicaid regulations and that I (we) may not charge in excess of the amount authorized on th...
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ACKNOWLEDGEMENTS AND SIGNATURE. I hereby acknowledge that I have received and read a copy of the Superior Uniform Group, Inc. 2003 Incentive Stock and Awards Plan and the prospectus for such plan, and understand the tax consequences of an exercise. Signature: Date: * * * * * * To be completed by: Received by:
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ACKNOWLEDGEMENTS AND SIGNATURE. I hereby acknowledge that I have received and read a copy of the Bandag, Incorporated 2004 Stock Grant and Awards Plan and the prospectus for such plan, and understand the tax consequences of an exercise. Signature: _______________________________ Date: _________________________ ****** To be completed by _____________________________: Received by: __________________________________________________ Date received: __________________________________________________
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ACKNOWLEDGEMENTS AND SIGNATURE. 1. I understand that all sales of Rock Creek Pharmaceuticals, Inc. common stock received upon exercise of this option are subject to compliance with the company's policy on securities trades.
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Related to ACKNOWLEDGEMENTS AND SIGNATURE

  • Acknowledgements and Agreements Executive hereby acknowledges and agrees that in the performance of Executive’s duties to the Company during the Employment Period, Executive shall be brought into frequent contact with existing and potential customers of the Company throughout the world. Executive also agrees that trade secrets and confidential information of the Company, more fully described in Section 8(h) gained by Executive during Executive’s association with the Company, have been developed by the Company through substantial expenditures of time, effort and money and constitute valuable and unique property of the Company. Executive further understands and agrees that the foregoing makes it necessary for the protection of the Company’s business that Executive not compete with the Company during Executive’s employment with the Company and not compete with the Company for a reasonable period thereafter, as further provided in the following sections. As a condition of Company entering into this Agreement, Executive must also execute the Company’s Proprietary Information and Assignments Agreement.

  • Acknowledgements and Consents Each of the parties hereby acknowledges and consents to the following:

  • Acknowledgements of Parties The parties to this Agreement hereby acknowledge that they are sophisticated business persons who were represented by counsel during the negotiations regarding the provisions hereof including, without limitation, the provisions of this Section 7, and are fully informed regarding said provisions. They further acknowledge that the provisions of this Section 7 fairly allocate the risks in light of the ability of the parties to investigate the Company and its business in order to assure that adequate disclosure is made in the Registration Statement and Prospectus as required by the Securities Act and the Exchange Act.

  • Acknowledgement and Agreement By execution below, the Transferor expressly acknowledges and consents to the pledge of the 2022-1 SUBI Certificate and the 2022-1 SUBI and the assignment of all rights and obligations of the Transferor related thereto by the Transferee to the Indenture Trustee pursuant to the Indenture for the benefit of the Noteholders. In addition, the Transferor hereby acknowledges and agrees that for so long as the Notes are Outstanding, the Indenture Trustee will have the right to exercise all powers, privileges and claims of the Transferee under this Agreement.

  • Acknowledgement and Reaffirmation By their execution hereof, each Borrower and the Guarantor hereby expressly (a) consents to this Amendment and to the amendments to the Credit Agreement set forth herein, (b) acknowledges that the covenants, representations, warranties and other obligations set forth in the Credit Agreement, the Notes and the other Loan Documents to which such Borrower or the Guarantor is a party remain in full force and effect (it being understood and agreed that to the extent any such covenants, representations, warranties or other obligations are expressly modified herein, such covenants, representations, warranties or obligations shall continue in full force and effect as expressly modified herein) and (c) acknowledges and agrees that this Amendment shall constitute a “Loan Document” for all purposes of the Credit Agreement and the other Loan Documents.

  • Acknowledgements The Borrower hereby acknowledges that:

  • Acknowledgement and Waiver 6.1 The Subscriber has acknowledged that the decision to purchase the Shares was solely made on the Company Information. The Subscriber hereby waives, to the fullest extent permitted by law, any rights of withdrawal, rescission or compensation for damages to which the Subscriber might be entitled in connection with the distribution of any of the Shares.

  • Acknowledgement 5. Staff and the Respondent agree with the facts set out in Part IV herein for the purposes of this Settlement Agreement only and further agree that this agreement of facts is without prejudice to the Respondent or Staff in any other proceeding of any kind including, but without limiting the generality of the foregoing, any proceedings brought by the MFDA (subject to Part IX) or any civil or other proceedings which may be brought by any other person or agency, whether or not this Settlement Agreement is accepted by the Hearing Panel.

  • ACKNOWLEDGEMENT AND CONSENT The Company is a party to the Company Collateral Documents, in each case as amended through the date hereof, pursuant to which the Company has created Liens in favor of the Agent on certain Collateral to secure the Obligations. The Parent Guarantor is a party to the Parent Collateral Documents, in each case as amended through the date hereof, pursuant to which the Parent Guarantor has created Liens in favor of the Agent on certain Collateral and pledged certain Collateral to the Agent to secure the Obligations of the Parent Guarantor. Certain Subsidiaries of the Company are parties to the Subsidiary Guaranty and/or one or more of the Subsidiary Collateral Documents, in each case as amended through the date hereof, pursuant to which such Subsidiaries have (i) guarantied the Obligations and/or (ii) created Liens in favor of the Agent on certain Collateral. The Company, the Parent Guarantor and such Subsidiaries are collectively referred to herein as the "Credit Support Parties", and the Company Collateral Documents, the Parent Collateral Documents, the Subsidiary Guaranty and the Subsidiary Collateral Documents are collectively referred to herein as the "Credit Support Documents". Each Credit Support Party hereby acknowledges that it has reviewed the terms and provisions of the Credit Agreement as amended by this Amendment and consents to the amendment of the Credit Agreement effected as of the date hereof pursuant to this Amendment. Each Credit Support Party acknowledges and agrees that any of the Credit Support Documents to which it is a party or otherwise bound shall continue in full force and effect. Each Credit Support Party hereby confirms that each Credit Support Document to which it is a party or otherwise bound and all Collateral encumbered thereby will continue to guaranty or secure, as the case may be, the payment and performance of all obligations guaranteed or secured thereby, as the case may be. Each Credit Support Party (other than the Company and the Parent Guarantor) acknowledges and agrees that (i) notwithstanding the conditions to effectiveness set forth in this Amendment, such Credit Support Party is not required by the terms of the Credit Agreement or any other Loan Document to consent to the amendments to the Credit Agreement effected pursuant to this Amendment and (ii) nothing in the Credit Agreement, this Amendment or any other Loan Document shall be deemed to require the consent of such Credit Support Party to any future amendments to the Credit Agreement.

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