Employment Application

Notification and Agreement Equal Opportunity Employer Statement Applicant’s Statement

ElderSpan Management, LLC supports the concept of Equal Employment Opportunity. Employment is based on personal qualifications and ability to perform the job. All employees and applicants shall be treated without discrimination or harassment on the basis of race, color, creed, ancestry, national origin, citizenship, age, sex/gender, pregnancy or childbirth, handicap or disability, arrest or conviction record, marital status, sexual orientation, religion, family status, student status, source of income, political beliefs, physical appearance, membership in the armed forces, use or nonuse of lawful products outside work during nonworking hours, or any other basis prohibited by federal, state or local law.

I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time with proper notice, and ElderSpan has the same right. No one other than ElderSpan has authority to modify this relationship or make any agreement to the contrary. Any such modification or agreement must be made in writing.

I understand that ElderSpan reserves the right to require me to submit to a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law.

I authorize ElderSpan to investigate my driving record, my criminal record and my credit history, and I understand that an investigative consumer report may be prepared whereby information is obtained through personal interviews with neighbors, friends, and others with whom I am acquainted. This inquiry would include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

I further understand that ElderSpan may contact my previous employers and I authorize those employers to disclose to ElderSpan all records and other information pertinent to my employment with them. I also authorize ElderSpan to provide truthful information concerning my employment with it to my future prospective employers and I agree to hold it harmless for providing such information.

I certify that all of the information that I provide in this application and/or resume and any interview will be true and accurate. I understand that if I am employed and any such information is later found to be false or misleading in any respect, I will be dismissed.

Do not sign until you have read and understand this statement.

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