PLEASE READ CAREFULLY BEFORE SIGNING APPLICATION

I have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out does not indicate that any positions are open, nor does it obligate the company to further process my application. My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials is true and complete to the best of my knowledge and constitutes authority to verify all information submitted on this application. I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews can be justification for refusal of employments or if employed, termination from Life At Home Health Care Agency.

I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with the Life At Home Health Care Agency in the position I am seeking. I understand that this application is not an employment contract for any specific length of time between Life At Home Health Care Agency and me, and that in the event I am hired, my employment will be “at-will” and either Life At Home Health Care Agency or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, manual, policy, and the like, distributed by Life At Home Health Care Agency to it’s employees is intended to or can create an employment contract, an offer of employment or any obligation on Life At Home Health Care Agency's part. Life At Home Health Care Agency may, at its sole discretion, hold in abeyance or revoke, amend, or modify, abridge, or change any benefit, policy practice, condition or process affecting its employees.

References: I hereby authorize Life At Home Health Care Agency and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services, or other entities listed by me in this form. Furthermore, I authorize Life At Home Health Care Agency and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.

Temporary/Contract Employment: If employed as a temporary or contract employee, I understand that I may be an employee of Life At Home Health Care Agency and not of any client. If employed, I further understand that my employment is not guaranteed for any specific time and may be terminated at any time for any reason. I further understand that a contract will exist between Life At Home Health Care Agency and each client to whom I may be assigned which will require the client to pay a fee to Life At Home Health Care Agency in the event that I accept direct employment with the client, I agree to notify Life At Home Health Care Agency immediately should I be offered direct employment by a client (or by referral of the client to any subsidiary or affiliated company), either for a permanent, temporary (including assignments through another agency), or consulting positions during my assignment or after my assignment has ended.