REIMBURSEMENT FORM

Reimbursements:

Terms for reimbursements are as follows:

Any required testing needed to be compliant for assignment & requested by D & D Second Chance Staffing Agency LLC will be reimbursed after you have worked a minimum of 10 (8-12 hr) shifts

Receipt must show:

• Date of Testing

• Name

• Amount Paid

You have 30 days after the 10th shift has been completed to request reimbursement or a 5% admin fee will be applied.

Items eligible for reimbursement:

• Drug Screen

• TB Testing

• CPR/BLS - up to $35

• Live Scan / Fingerprinting
  
• Physical Exam - up to $100