Agreement

1. I, an employee of Saint Mary’s Health Care / Advantage Health, hereby authorize Saint Mary’s Health Care to deduct the amount specified above from my paycheck for the specified uniforms for the number of pay periods listed. Deduction begins with the first pay of the month following purchase date.

2. If this is an annual deduction, I, an employee of Saint Mary’s Health Care / Advantage Health, hereby authorize Saint Mary’s Health Care to deduct the specified amount, per pay period. Deduction begins with the first pay of the month following purchase date.

3. I also further authorize / Saint Mary’s Health Care, upon termination of employment for any reason, to withhold payment of any expense reimbursement, PTO pay or any other payments to which I may be otherwise entitled, up to the amount of any unpaid principal under this note.

4. I acknowledge and declare

• This authorization is given knowingly, voluntarily and without intimidation or threat of loss of employment, and the deductions made hereunder are for my benefit.
• Neither this authorization, nor any loan made in connection with this authorization, confers any right to continuing employment or any other employment rights.
• In the event that the total amount is not deducted or that my final check does not cover the full amount owed, I understand that I am responsible for the remaining balance.
• The giving of this authorization does not limit or restrict Saint Mary’s Health Care’s right to obtain repayment in part or in full through other means.