List below your last four employers, starting with the MOST RECENT one first, whether temporary, seasonal, paid, unpaid, or voluntary.

Give the names of three persons, not related to you, whom you have known for at least one year.

Have you ever been convicted of a crime or entered a plea of guilty or no contest to a crime? (If yes to this question, it does not constitute an automatic rejection for employment. Date of offense, seriousness and nature of violation, rehabilitation and position applied for will be considered.)

Continuing Healthcare Solutions, Inc. does not discriminate on the basis of race, creed, national origin, sex, color, age or non-job related handicap or disability. Continuing Healthcare Solutions, Inc. insists that all of its employees can perform the essential functions of their employment and have the character, integrity and general reputation for honesty of a person that Continuing Healthcare Solutions, Inc. would have represent it in its dealings with customers, suppliers and/or other employees. Accordingly, we insist on complete honesty. ANY LATER DISCOVERY THAT AN APPLICANT WAS NOT HONEST IN COMPLETING THIS APPLICATION WILL BE GROUNDS FOR DISCHARGE.

I certify the answers given herein are true and complete to the best of my knowledge and are subject to confirmation by “CHSES”. I hereby acknowledge notification, in compliance with the Fair Credit Reporting Act, that “CHSES” may make such investigations of my personal, employment, financial, or other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and all other persons contacted from all liability. I understand that nothing in this application is intended to imply or create an employment relationship or contract for employment. I further understand that, if hired, my employment is at-will and can be terminated at any time, with or without notice, for any reason. I also understand that while personnel policies, programs, and procedures may, out of necessity change from time to time, such at-will status is not subject to change absent a written agreement signed by the CEO of “CHSES” or a designated authorized representative. “CHSES” reserves and retains the right to make changes in terms and conditions of my employment as the employer determines to be appropriate. I also understand and agree that “CHSES” supports the Drug Free Workplace concept and as such may require me to submit to a drug test as a condition of employment or continued employment. These drug tests may be administered at anytime. Refusal to submit to any drug test will disqualify an applicant or will result in termination of employment. If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment. I understand that emergency conditions may require me to temporarily work shifts other than the one for which I am applying and agree to such scheduling changes as directed by my department head or administrator of this institution. I understand that my offer of employment is contingent upon satisfactory results from a physical examination and background check. I also acknowledge that “CHSES” may request previous employment information to evaluate my qualifications for employment and that “CHSES” is authorized to investigate all statements made by the applicant on the application, to contact former employers and references, and to advise contacted persons that they may respond to questions. I understand that false or incomplete information in an application for employment is grounds for dismissal and forfeiture of all related benefits. I understand that I am required to abide by all company rules and regulations. I understand that my employment is at-will, and that either party is free to terminate the employment relationship at any time with or without notice for any reason or no reason at all. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.