I certify that the information on this application and its supporting documents are accurate and complete. I understand and agree that failure to fully complete the form, misrepresentation, or omission of facts represents grounds for elimination from the consideration for employment or termination of employment if discovered at a later date.

I authorize Community Residential Supportive Services Home Health, Inc. to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability to make full response to any inquires in connection with this application for employment. If requested I agree to submit to a physical exam, criminal and credit background investigation, screening for illegal substances upon conditional offer of employment. I understand this document is not an offer for employment, and that an offer of employment if tendered does not constitute a contract for continued guaranteed employment. I understand that my employment with Community Residential Supportive Services Home Health, Inc. is "at will" and the employment relationship may be terminated at any time by either party, for any or no reason other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the Unties States.

By clicking "SUBMIT" below, I am signing the Application and I agree to all of its terms. I agree that Community Residential Supportive Services Home Health, Inc. may use a copy of the electronically signed Application in the same manner as if I had signed a paper application.