LIST THE NAMES OF ALL EMPLOYERS, GIVING THE MOST RECENT POSITION FIRST. PLEASE GIVE THE MONTH AND YEAR FOR
EACH POSITION LISTED. IN ADDITION, BE SURE TO LIST ALL HEALTH OR HUMAN SERVICE PROVIDERS FOR WHICH YOU HAVE
WORKED. IF YOU NEED ADDITIONAL SPACE, PLEASE CONTINUE ON ANOTHER SHEET OF PAPER.
I hereby give Atlas Home Care Services LLC, hereafter known as AHCS, the right to
thoroughly investigate my past employment, education, police record, activities, and I release from all
liability all persons, companies, and corporations supplying such information. I indemnify AHCS against any
liability which might result from conducting such an investigation.
I understand that any false answers or statements or implications made by me in this
application or other required documents shall be considered sufficient cause for denial of employment or
discharge.
Additionally, I understand that nothing contained in this employment application or in
the granting of an interview is intended to create an employment contract between AHCS and myself for either
employment or for the providing of any benefit. No promises regarding employment have been made to me and I
understand that no such promise or guarantee is binding upon AHCS unless made in writing by the President.
If any employment relationship is established, I understand that I have the right to terminate my employment
at any time for any reason or no reason at all, with or without prior notice, and that AHCS retains the same
right.