Contract:
CareStaf does not discriminate in the provision of services or employment because of race, religion, color, sex, age, marital status, national or ethnic origin, physical or mental disability, or any other protected basis. I hereby authorize the schools, companies, former employers and all other persons named in this application to give any information regarding my employment, education, driving record, conviction records or character. I hereby release Carestaf and said schools, agencies, companies, former employers and all other persons named in this application from all liability for any damages resulting from issuing this information. I agree, during my employment with Carestaf, I am strictly prohibited from seeking or accepting employment, either directly or indirectly, in any capacity, from any home care, private duty or facility client assigned to me by Carestaf. I am also strictly prohibited from seeking or accepting employment, either directly or indirectly, in any capacity from any home care, private duty or facility client assigned to me by Carestaf after my assignment ends with any such client for any reason and for a period of ninety (90) calendar days thereafter. I understand that Carestaf explains this Non-Solicitation/Finder's Fee Policy to all Carestaf clients and enforcse this policy against clients and employees who violate it. I understand that my violation of the policy may subject me to disciplinary action and/or legal action for which Carestaf will seek damages in an estimated amount of up to $10,000, as well as all other available remedies in law and equity. I understand and agree that nothing contained in this employment application or granting of an interview creates an employment contract between Carestaf 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 promise or guarantee is binding upon Carestaf unless made in writing prior to the date of this application. If an employment relationship is established, I understand that my employment will be terminable "at will," that I will have the right to terminate my employment at any time, and that Carestaf will retain a similar right to terminate my employment at any time. I agree not to transport a client in my vehicle or their vehicle without the express knowledge and permission of Carestaf. I certify that the foregoing answers to the questions asked in this application and on the accompanying Work Experience Record are true and correct to the best of my knowledge. I understand that falsification of information or misinformation hereon may result in discharge at any time it becomes known by Carestaf.

Acceptance:

I affirm that the information provided is true and correct to the best of my knowledge. I understand that failure to provide true and correct information may result in the rejection of my application. I agree to the terms and conditions described in the "Contract" above. I understand that entering my Name and the Date in the Acceptance area immediately below is in all respects equivalent to the affixation of my written signature.

Acceptance:

Name:   Date:

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