I certify that the facts contained in this application, and accompanying resume, if any, are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application will be grounds for termination from Providence Home Care Agency.

I authorize a criminal background check as well as an investigation of all statements contained in this application regarding my school/work history as well as references to obtain information on their experiences with me. If hired/contracted, I agree to a criminal background check and to be fingerprinted for the FBI Clearance. Upon termination, I authorize the reference information to potential employers.

All qualified candidates receive consideration for employment without regard for race, color, religion. nationality, ethnicity, sexual orientation, the presence of an accommodatable condition or disability, veteran's status or other categories protected by law.

I voluntarily disclose I have a condition that requires reasonable accommodations.

I hereby authorize any person, educational instruction, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold Providence Home Care Agency, any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.