MEMORANDUM OF AGREEMENT

WORKSITE AGREEMENT

1. ___________________________________________________________________________, the employer, located at

____________________________________________________________________________________________agrees to
provide a Put Illinois to Work worksite, an on site supervisor or mentor to oversee the trainee-worker in the job and to
accurately report for payroll purposes on timesheets provided the times worked by the trainee-worker at the site.

2. This agreement was negotiated with

___________________________________________________________________________________________

acting as an authorized agent of the Illinois Department of Human Services (hereafter IDHS) through Heartland Human
Care Services, Inc ® its statewide lead agency.

3. The purpose of this Agreement is to establish rights and responsibilities of the parties.

4. The purposes of the Put Illinois to Work program are to foster economic recovery and put Illinoisans back to work
earning income to support themselves and their families by subsidizing employment through September 30, 2010, to
unemployed or underemployed parents of children and to youth aged 18 through 21 who otherwise meet the TANF eligibility
requirements of IDHS.

5. Put Illinois to Work is funded by the State of Illinois and the Temporary Assistance for Needy Families (TANF)
Emergency Contingency Fund (ECF). IDHS is the responsible state agency claiming the available American Recovery and
Reinvestment Act funds and is the lead state agency responsible for the Put Illinois to Work initiative.

6. IDHS agrees to draw down and deliver the Federal ARRA funds to ensure trainee-worker(s) are paid on a regular payroll
cycle.

7. Heartland Human Care Services, Inc. ® (hereafter HHCS) consistent with its contract with IDHS agrees to serve as the
employer of record for purposes of Put Illinois to Work. HHCS will be responsible for the direction and control of the
trainee-workers, including:
a) Assignment of trainee-workers to appropriate worksites, and removal if necessary,
b) Approval of the number of hours worked by trainee-worker,
c) Payroll issuance to the trainee-worker,
d) Workers Compensation Insurance, if applicable,
e) Payroll taxes including the employer portion of Social Security taxes, and
f) Reporting the trainee-worker’s income to the Internal Revenue Service.

8. HHCS as the employer of record will maintain I-9 records but will provide the employer with copies of said documents if
requested.

9. HHCS or its authorized agent will provide documentation if appropriate for the trainee worker to be pre-qualified for the
Work Opportunity Tax Credit should the employer choose to hire the trainee-worker.

10. HHCS agrees to ensure every trainee-employee has received a unique Payroll Visa card which every two weeks will be
loaded with the earnings of the trainee-worker. At no time is the employer responsible for payroll. The employer and the
trainee-worker will be provided with an 800 line and an email address should there be any payroll related problem.

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11. In the event that the Illinois Department of Employment Security, or court, determines that Put Illinois to Work is not a
work-relief program, employers would be responsible for any successful unemployment insurance benefit claims submitted
by trainee-worker(s).

12. The employer agrees to provide job experience, skill acquisition and meaningful work to the trainee worker(s) that is
relevant to jobs in the employer or in the sector. The employer is not being separately compensated for this service.

13. The employer agrees to mentor and supervise the trainee-worker(s) to ensure skill and experience acquisition adequate to
pursue the employment. The employer is not being separately compensated for this service; it is the employer’s in-kind
contribution to Put Illinois to Work.

14. The employer agrees to allow IDHS to count the employer’s supervision and training expenses toward the state’s
Maintenance of Effort (MOE) requirement under the TANF program. The employer certifies that this supervision and
training is being provided by staff that is funded by private funds or if funded solely by Non-Federal funds.

15. The employer agrees to prepare the timesheets in a customary businesslike fashion, ensuring accuracy as to the hours
worked and to provide said timesheets for the trainee-worker(s) in a timely fashion to the designated lead agency to ensure
payroll can be processed.

16. The employer agrees that the trainee-worker shall work at least 30 hours per week but not more than 40 hours per week
and will document the hours accurately.

17. The employer shall provide the trainee-worker with any tools, equipment, safety gear or uniforms required to perform
the work at the worksite.

18. The employer agrees to maintain and preserve the confidentiality of its trainee-worker(s) as it would of any employees.
Furthermore, the employer agrees to refrain from providing the names of trainee-workers to media or other non-parties to
this contract.

19. The employer affirms that if the worksite is subject to a collective bargaining agreement, the employ of trainee-workers
under Put Illinois to Work in no way impairs the terms of the contract. Moreover, the employer affirms that the trainee-
workers are not being employed as replacement workers during a labor dispute and that no employee has been displaced or
had hours reduced to employ trainee-workers.

20. Employers shall abide by the following provisions throughout the Put Illinois to Work program:
a) Employers cannot employ family members as part of the Put Illinois to Work program. Trainee-workers may not be
related by blood or marriage to the Employer.
b) Participating employers may not:
a. Be engaged in the adult entertainment industry,
b. An organization whose primary business is the sale and distribution of packaged liquors,
c. Place trainee-workers in positions in which their primary duty is to promote religious views,
d. Be political organizations or participate in campaigning or lobbying activities, or
e. Be engaged in the sale of firearms as their primary business.
c) Employers may only place Put Illinois to Work trainee-workers into positions that would not exist but for the Put
Illinois to Work program. Therefore employers may not fill positions that were vacated after March 15, 2010 with
Put Illinois to Work participants, and may not reduce hours of existing employees in order to employ Put Illinois to
Work trainee-workers.
d) Employers may not lay off an employee, and then rehire that employee or otherwise fill the position through the PIW
program
e) Employers agree to comply with all applicable labor laws.
f) Put Illinois to Work trainee-workers must not comprise more than 50% of the business' workforce at each worksite
g) Employers will be expected to consider Put Illinois to Work trainee-workers for unsubsidized positions at the end the
Put Illinois to Work program. However, providing unsubsidized employment for trainee-workers is not a
requirement of the program.

21. HHCS and its authorized agents reserve the right to, in consultation with IDHS, terminate the relationship with any
employer who fails to provide an appropriate work environment for Put Illinois to Work trainee-workers.

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TERM
This Agreement shall become effective upon the date of execution by the Employer and HHCS or its authorized agent, and
shall terminate on September 30, 2010. The employer assumes all responsibility for the trainee-worker as of October 1, 2010
if the employer keeps them employed at the worksite. This agreement for Put Illinois to Work can only be extended by
written agreement of the lead agency or IDHS.
 This Agreement shall be governed and construed in accordance with the laws of the State of Illinois.
 This Agreement may be modified or amended at any time during its term by mutual consent of the parties expressed
in writing, and signed by the parties.
 Either party upon thirty (30) days written notice to the other party may terminate this Agreement.
 This Agreement, including the rights, benefits and duties hereunder, shall not be assignable without the prior written
consent of the other party.
 Invalidity of any provision, term or condition of this Agreement for any reason shall not render any other provision,
term or condition of this Agreement invalid or unenforceable.

Employer

Authorized Signature

__________________________________________________________________________________________
Printed Name and Title

Date

Agent Organization

Authorized Signature

Printed Name and Title

Effective Date

Illinois Department of Human Services

Authorized Signature

Printed Name and Title

Date

The following organizations are authorized by IDHS and HHCS to enter into this MOU: