APPLICANT MUST FILL OUT A COMPLETE EMPLOYMENT APPLICATION BEFORE THE INTERVIEWING PROCESS BEGINS

READ CAREFULLY BEFORE SIGNING

I certify that the above information is true and complete to the best of my knowledge, without omission of any consequence. I agree that any misrepresentation, false statement, or omission, made by me with respect to the information contained in the application or subsequent physical examination shall be sufficient cause to terminate my employment. I agree that any offer of employment, and acceptance thereof, does not constitute a binding contract of any length, and that such employment is terminable at the will of either party, subject to applicable state and/or federal laws. I also authorize you to solicit reports from previous employers, schools, personnel, and other references, and law enforcement agencies (if I have been convicted of a felony). I realize that JM Arbor Care is an Equal Opportunity Employer.

• 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 terminations 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.
• 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.
• 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.
• I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference, or insurance company contacted by JM Arbor Care or their agent, to furnish the information described in Section I.