Data Protection Statement The personal information (data) collected on this form, are used only for the purpose of this employment. Equality of Opportunity Statement The Agency’s Equal Opportunities Policy covers all employees, or potential employees, and embraces the principle that all people shall be treated equally, regardless of their age, gender, ethnic origin, nationality, colour, religion, marital status, sexual orientation, religion or belief, disability, or offending background.

Please fill out the paragraph below with your signature.

Record of conviction does not necessarily disqualify an applicant from employment considerations.

Confidentiality Statement

We consider it an essential practice to uphold the confidentiality of your personal information. We do not allow third parties to gain access to your personal information without your consent. Information that is collected through online forms will be kept confidential.

SIGNATURE and DECLARATION

I understand and agree that: Any material misrepresentation or deliberate omission of a fact in my application may result in refusal of or if employed, immediate termination from employment. Although management makes every effort to accommodate individual preference, business needs may at times make the following conditions mandatory: overtime, shift work, rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment. It is my understanding that About Family Healthcare LLC will make a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by About Family Healthcare LLC and I release from liability any person giving or receiving such information. I agree that my employment is at will and may be terminated by About Family Healthcare LLC or me at any time with or without notice or cause and without liability for wages or salary except such as may have been earned at the date of such termination. I further understand this is an application for employment and that no employment contract is being offered, nor will any result from my employment with About Family Healthcare LLC. I understand that if I am employed, such employment is for no definite period of time and that About Family Healthcare LLC can change wages, benefits, and conditions at any time.

I acknowledge that any oral representation or written statements which may have been made to me to the contrary of this paragraph are expressly disavowed and may not be relied upon.