Team Placement Service, Inc.
DENTAL TIMESHEET & CLIENT AGREEMENT
1414 Prince Street, Suite #202, Alexandria, VA 22314
703-820-8618 (T)
703-820-3368 (F)
Associate Name________________________________________________________________________________________
Address_______________________________________________________________________________________________
Telephone_____________________________________________

Check if Change of Address
Job Title______________________________________________
Week Ending___________________________
Name of Client/Practice___________________________________________________________________________________
Telephone_____________________________________________
PLEASE PRINT CLEARLY AND COMPLETE ALL SECTIONS.
Associate must fax Timesheet to Team Placement no later than 12:00 pm Monday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Date
Time-In
Lunch Out
Lunch In
Time Out
Total
Total Hours for this Assignment this Week
 Returning to Assignment
 Assignment Complete
Time Card Instructions:
1.
A separate Timesheet (provided with each paycheck) is to be used for each week and each assignment.
2.
Client and Associate must verify all hours are accurate.
3.
Time worked is paid by the hour and in 15-minute increments. Daily and weekly hours must be totaled.
4.
Client and Associate must sign Timesheet.
5.
It is the responsibility of the Associate to verify that Team Placement received the faxed/mailed Timesheet.
6.
Associate should contact Team Placement at the end of each assignment.
______________________________________________________
Signature of Associate
_______________________________________
Date
I, the undersigned, understand that by signing this Timesheet, I am verifying that the time worked as indicated above
is accurate and the employee performed satisfactorily. I also agree to all terms and conditions of the Agreement as it
appears on the reverse of this form. No other agreement, written or oral, exists between the parties.
______________________________________________________
Authorized Signature of Client/Practice
________________________________________
Date
Fax Copy of Timesheet to Team Placement @ 703-820-3368 no later than 12:00 pm Monday.
DENTAL TEMPORARY PLACEMENT AGREEMENT
The following Agreement outlines the terms and conditions of services provided by Team Placement Service, Inc. (TPS). All fees,
terms, and conditions apply if a candidate is hired directly or indirectly due to efforts or referral provided by TPS within one (1)
year of referral. This Agreement covers candidates hired full and part time as well as on a subcontracting basis. TPS fees are based
on all compensation, benefits, bonuses, and incentives paid to the candidate.
Temporary Placements Fee Client agrees to pay the verbally agreed upon bill rate for the period of work included on the reverse
timesheet. The Client agrees to be responsible for the candidate’s management and safety. TPS agrees to be responsible for all
payroll, benefits, and taxes as well as general liability, worker’s compensation, and staffing service liability insurance. Requests for
extensions and/or additional personnel must be approved by a TPS representative only. It is understood and agreed that the
candidate is an employee at-will and may be terminated or resign without notice. TPS reserves the right to withhold placing a
temporary candidate at any time and for any reason. Should the Client chose to hire the candidate on a full time basis, TPS may
charge the Client a placement fee of up to twenty-five percent (25%) of the first years compensation. Upon permanent placement,
all compensation, benefits, taxes, insurance, and all pre-employment screening would become the Client’s responsibility.
Compliance With Federal Law TPS is an Equal Opportunity Employer. TPS complies with all applicable laws and regulations
pertaining to executing this contract. Referrals of permanent applicants or temporary employees are made on the basis of merit,
experience, and skill level.
Limitation of Liability TPS will provide the Client with the results of all background investigations, reference checks, drug tests,
and any other information gathered by TPS concerning any applicant whom the Client wishes to consider for employment. This
information is being furnished by third parties and TPS makes no express or implied warranty about such information or the
applicant. The information will be furnished to the Client as it has been received by TPS. The decision or whether or not to offer
permanent employment to a person submitted by TPS will be made exclusively by the Client in the exercise of its business
judgment. TPS assumes no liability in connection with such hiring.
Confidentiality TPS shall not, in any manner, for any reason, either directly or indirectly, divulge or communicate to any person,
firm, or corporation, any of the Client’s confidential information except as required by the Federal, State, and local law, without the
express permission of the Client. The Client shall not discuss, report or disclose TPS placement fees with any agency, industry
competitor, or any current, future, or potential Client of TPS unless prior authorization in writing has been granted by TPS.
Hold Harmless Each party agrees to indemnify and hold harmless the other party from any and all negligence and all liabilities,
claims, losses, costs, damages, and expenses resulting or arising from or connected with the services rendered by the other party, its
agents, independent contractors, or employees during the contract period.
General Conditions No amendments or changes to this contract shall be effective unless in writing and signed by each party. This
agreement may not be assigned without prior written consent of TPS. This agreement shall be deemed to have been made and shall
be construed with all the rights, powers and liabilities of the parties within in accordance with the laws of the Commonwealth of
Virginia. This contract shall supercede any previous contract between TPS and the Client for above referenced services.
Payment Client shall be invoiced for the services provided based on the current rate, and Client agrees to pay invoices upon receipt.
Accepted forms of payment include cash, check, VISA, and MasterCard. If TPS does not receive payment within thirty (30) days of
the invoice date, then the payment will be considered past due and TPS shall assess a monthly finance charge of one and one-half
percent (1 ½%) on the unpaid balance. Overdue accounts will be sent to Collections. TPS reserves the right to discontinue service if
the past due balance remains unpaid. Client shall pay TPS’ reasonable attorney fees and costs if TPS takes legal action to collect
any unpaid balance. Payment should be made to Team Placement Service, Inc. and mailed to: 1414 Prince Street, Suite #202,
Alexandria, VA 22314.