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 ot 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 also constitutes authority to verify any and 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 employment, or, if employed, termination from that Company's employ.

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 Company in the position I am seeking.

I understand that this application is not an employment contract for any specific length of time between the Company and me, and that in the event I am hired, my employment will be "at will" and either the Company or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, contract, an offer of employment or any obligation on the Company's part. The Company 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 the company and its agents to make such investigations and inquiries into my employment and educational history and other related matters as it may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquiries 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. Futhermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.

Temporary/PRN/Contract Employment: If employed as a temporary, Pro Re Nata or contract employee, I understand that I may be an employee of the company 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 the company and each client to whom I may be assigned which will require the client to pay a fee to the company in the event that I accept direct employment with the client, I agree to notify the company 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.

RELEASE/AUTHORIZATION

In connection with my consideration for employment ot reassignment, I understand that this perpective employer or its agent COMPU-FACT RESEARCH, INC. may be performing an investigation consumer report about me, which will include my character, work habits, performance, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, information from public and private sources may be requested. These sources may contain records regarding my driving record, worker's compensation inquiries, court record, credit credentials, education and references.

I realize that if medical or worker's compensation information is obtained about me, it will be utilized in compliance with Federal Americans with Disabilities Act (ADA) and/or any other state laws. I realize that according to the Fair Credit Reporting Act, I am enitiled to know if I am being denied employment by this perspective employers because of information obtained from a consumer reporting agency. If this is the case, I will be notified and given the information source or the reporting agency's name and address.

I acknowledge that a telegraphic facsimile (FAX) or photographic copy shall be as vaild as the original.

I hereby authorize, without reservation, any law enforcement agency, information service bureau, institution, school, employer, reference or insurance company contacted by COMPU-FACT RESEARCH, INC., or its agent, to furnish the above-mentioned information.

The following information is required by law enforcement agencies and other entities for postive identification when checking public records. It is confidential and will not be used for ant other purposes. I hereby release the employer and agents and all person, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above-mentioned information or reports.

1099 ACKNOWLEDGMENT 

This memo is intended to provide generalized information to all team members, that each member shall be responsible for paying their own taxes and filling their own 1099 form.

You are an independent contractor and are contracting your services to Elizabeth's Helping Hands Homecare, LLC. We will inform you of available shifts, and you either accept or decline the shift. If the shift is accepted, you are obligated to show up for your shift and show on time.

Being that Elizabeth's Helping Hands Homecare, LLC does not withhold from your payment nor pay a percentage of your taxes, you will need to pay your own taxes in full.

The company will be responsible for filling out the appropriate 1099 tax form and sending it to all team members by January 31st. The income you receive for Elizabeth's Helping Hands Homecare, LLC will be reported on FORM 1099 - MISC.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE CONTENTS OF THIS MEMO.

Please provide 7 years of address history