Code of Conduct and Standards

Certification of Compliance
I have read and received a copy of the Code of Conduct and Standards. I have had the
opportunity to ask any questions I might have with regard to its contents and believe I
understand fully how the policies relate to my contract.

I hereby acknowledge my obligation and agreement to fulfill those duties and

responsibilities as set forth in the Code of Conduct and the Standards and to be bound
by these standards.

I further certify that, throughout the remainder of my association with Jireh Counseling
and Consulting Services, Inc., I shall continue to comply with the terms of the Codes of
Conduct and Standards.

I understand that violations of the Code of Conduct or Standards may lead to

disciplinary action, up to and including contract termination.

________________________________________________ ________________
Signature Month / Day / Year

(Name Please Print)

BF100-Code of Conduct Certification Est. Mar 2008