Exhibit 4.10
STAFF BUILDERS, INC.
1993 EMPLOYEE STOCK PURCHASE PLAN
SUBSCRIPTION AGREEMENT
__________ Original Application Enrollment Date: _____________________
__________ Change in Payroll Deduction Rate
__________ Change of Beneficiary(ies)
1. _________________________________________________ hereby elects to
participate in the Staff Builders, Inc. 1993 Employee Stock Purchase Plan
(the "1993 Employee Stock Purchase Plan") and subscribes to purchase shares
of the Company's Common Stock in accordance with this Subscription
Agreement and the 1993 Employee Stock Purchase Plan.
2. I hereby authorize payroll deductions from each paycheck in an amount equal
to ______% (not to exceed 10%) of my Compensation on each payday during the
Offering Period in accordance with the 1993 Employee Stock Purchase Plan.
(Please note that no fractional percentages are permitted.)
3. I understand that said payroll deductions shall be accumulated for the
purchase of shares of Common Stock at the applicable Purchase Price
determined in accordance with the 1993 Employee Stock Purchase Plan. I
understand that if I do not withdraw from an Offering Period, any
accumulated payroll deductions will be used to automatically exercise my
option to purchase shares of Common Stock.
4. I acknowledge that I have received a complete copy of the 1993 Employee
Stock Purchase Plan. I understand that my participation in the 1993
Employee Stock Purchase Plan is in all respects subject to its terms.
5. Shares purchased for me under the 1993 Employee Stock Purchase Plan should
be issued in the name(s) of (Employee or Employee and spouse only):
_______________________ ____________________________________.
6. I hereby agree to notify the Company in writing within 30 days after the
date of any disposition of my shares and that adequate provision will be
made for federal, state or other tax withholding obligations, if any, which
arise upon the disposition of shares of Common Stock.
7. I hereby agree to be bound by the terms of the 1993 Employee Stock Purchase
Plan. The effectiveness of this Subscription Agreement is dependent upon
my eligibility to participate in the 1993 Employee Stock Purchase Plan.
8. In the event of my death, I hereby designate the following as my
beneficiary(ies) to receive all payments and shares due me under the 1993
Employee Stock Purchase Plan:
NAME: (Please print):_____________________________________________________
(First) (Middle) (Last)
___________________________ __________________________________________
Relationship
__________________________________________
(Address)
NAME: (Please print):_____________________________________________________
(First) (Middle) (Last)
___________________________ __________________________________________
Relationship
__________________________________________
(Address)
9. Capitalized terms used herein but not otherwise defined in this
Subscription Agreement shall have the respective meanings ascribed to them
in the 1993 Employee Stock Purchase Plan.
I UNDERSTAND THAT THIS SUBSCRIPTION AGREEMENT SHALL REMAIN IN EFFECT THROUGHOUT
SUCCESSIVE OFFERING PERIODS UNLESS TERMINATED BY ME.
Dated:______________________ _______________________________________________
Signature of Employee
_______________________________________________
Spouse's Signature (if beneficiary is other than
spouse)
Employee's Social
Security Number: _______________________________________________
Employee's Address: _______________________________________________
_______________________________________________
_______________________________________________
STAFF BUILDERS, INC.
1993 EMPLOYEE STOCK PURCHASE PLAN
NOTICE OF WITHDRAWAL
The undersigned participant of the Staff Builders, Inc. 1993 Employee
Stock Purchase Plan hereby notifies the Company that he or she hereby withdraws
from the current Offering Period which began on ____________________, _____.
The undersigned directs the Company to pay to the undersigned as promptly as
practicable all the payroll deductions credited to his or her account with
respect to such Offering Period. The undersigned understands and agrees that
his or her option to purchase shares during such Offering Period will be
automatically terminated. The undersigned understands further that no
additional payroll deductions will be made for the purchase of shares in the
current Offering Period and the undersigned shall be eligible to participate in
succeeding Offering Periods by delivering to the Company a new Subscription
Agreement.
Name and Address of Participant:
_______________________________________________
_______________________________________________
_______________________________________________
Signature:
_______________________________________________
Date:___________________________________________
