PER DIEM ELIGIBILITY CERTIFICATION

I. Basic Information

Employer: Synesis Inc_______________

Employee: ______________________________

Home Address: ______________________________

Customer: ______________________________

Work Address: ______________________________

Estimated Distance: miles

Basic Rate: $_______ per hour
Per Diem Rate: $_______ per hour
Overtime Rate: $_______ per hour

II. Basic Information

I, ______________________________, certify that I am eligible to receive per diem as defined and limited by any applicable section of the United States Internal Revenue Code.

1. Per diem will be paid on the first forty hours of work each week.

2. If this certification is executed at a later time than the basic employment agreement, the rates contained herein take precedence.

3. Any change in status that affects your eligibility for per diem will be reported to us immediately. Appropriate changes to the compensation plan will be executed to reflect your new status.