Certification and Understanding

I certify that the answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at employment decision. I understand that this application is not and is not intended to be a contract for employment.

In the event that I receive and accept an offer of employment from this company, I understand that false and/or misleading information given in my application or interview(s) may result in discharge and that my employment may be terminated by the company or by me at any time, with or without cause, subject to applicable requirement of law at which point all property belonging to the company will be returned. Additionally, I understand that I am required to abide by all rules and regulations of the company.

I understand that as part of the company's employment procedures, an investigative report may be made whereby information is obtained from third parties, such as family members, business associates, former employers, friends or others. This inquiry may solicit information as to my work and records, character, general reputation and personal characteristics.

We are an equal opportunity employer. All applicants for employment will be considered on the basis of merit and job qualifications without regard to race, color, religion, sex, sexual orientation, national origin, age, marital or veteran status, or the presence of non-job related medical condition or handicap.

Release Authorization

I. In connection with my application for employment, I understand that a consumer report or an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my: workers' compensation injuries, driving record, court record, education, credentials, credit, and references. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

II. Medical and workers' compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a Consumer Reporting Agency. If so, I will be notified and given the name and address of the agency or the source that provided the information.

III. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county agencies.

IV. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by Labor of Love Homecare Services or its agent, to furnish the information described in Section 1.