NOTE: Criminal offenses include felonies and misdemeanors. A guilty plea, guilty verdict, or plea of nolo contendere is a conviction even if, upon sentencing, you were never imprisoned, only paid a fine, were conditionally or unconditionally discharged, or received a Certificate of Relief fcrom Disabilities. You do not have to disclose any material sealed, expunged, or set aside under Fuderal or State law, or any juvenile delinquent or youthful offender adjudications. You are not considered a youthful offender simply because of your age at the time of the offense. Only a specific court finding determines youthful offender status. You will NOT be automatically disqualified because of a criminal conviction.

NOTE: A "pending" criminal charge is one that results from an arrest or after the filing of a criminal information or indictment and that has NOT been resolved by acquittal, conviction, dismissal, or nolle prosequi. You will NOT be automatically disqualified because of pending criminal charges

Please read carefully

I am applying for employment with CareFix Staffing. I affirm that all of the information contained in this application is true and complete, and I understand that any falsification, misrepresentation or omission may result in refusal of employment, withdrawal of an offer of employment, or immediate dismisal from employment. I understand further that CareFix Staffing will report all instances of suspected fraud or misrepresentation to the appropriate licensing and/or regulatory bodies.

I understand that if I am hired by CareFix Staffing, that I will be an at-will employee during the extent of my employment, which means that either I or CareFix Staffing can terminate my employment with or without cause and with or without prior notice. I understand that no one other than CareFix Staffing's human resources officer has the authority to alter my employment status.

I understand that any offer of employment made by CareFix Staffing is also expressly conditioned upon CareFix Staffing's confirmation that I am not currently excluded from participation as a supplier or provider under any federal or state healthcare program and I am not currently under investigation or facing charges which could lead to my exclusion from participation in any such program. I understand that if CareFix Staffing is not able to verify these things to its satisfaction, CareFix Staffing may rescind any job offer or terminate my employment.

I understand that any offer of employment made by CareFix Staffing is expressly conditioned upon CareFix Staffing investigation of my background. In conducting any background checks CareFix Staffing will comply with the Fair Credit Reporting Act.

I understand that, as a condition of employment, I will be required to provide proof of employment eligibility.

If I am applying for a position that requires a license, registration and/or certification, I understand that any offer of employment made by CareFix Staffing is expressly conditioned upon my providing proof satisfactory to CareFix Staffing that I have a current license, registration and/or certification of the kind required. I understand that if CareFix is not able to verify my license, registration and/or certification to its satisfaction, my job offer may be rescinded or my employment terminaated. I understand that falsification or alteration of records, certifications, licenses or credentials of any sort will not be tolerated. I understand further that CareFix Staffing will report all instances of suspected fraud or misrepresentation to the appropriate licensing and/or regulatory bodies.

I understand that any offer of employment made by CareFix Staffing is also expressly conditioned upon my submission to a drug test. If I refuse to consent to or cooperate in the conduct of such a test, or if I test positive for a controlled substance, I understand that CareFix Staffing may rescind any job offer or terminate my employment.

I agree to submit to post offer physical examination as permitted by law.

I agree that I will be bound by and will adhere to any other rules and policies issued by CareFix Staffing, including the policy manual, all other published rules, procedures and guidelines.

Acknowledgment*