ACKNOWLEDGMENT AND RELEASE TO OBTAIN INFORMATION

I have answered all of the above questions to the best of my ability. I hereby certify that there are no omissions of any kind, and no misrepresentations or falsifications, and that the above answers are true and accurate and are made in good faith. I understand and acknowledge that any omission I have made or misrepresentation or falsification in this application or in any pre-employment document may be grounds to discontinue further consideration of my application, or for immediate termination of my employment at any time if already hired.

I further understand and acknowledge that, if Maplewood Senior Living offers me employment, such employment is on an at-will basis, and that both Maplewood Senior Living and I shall be free to end the employment relationship at any time and for any reason, should I choose to accept the offer. In the event of my employment by Maplewood Senior Living, I will comply with all rules and regulations as set forth in Maplewood Senior Livings policy manual or the communications distributed to all employees, and as the same may from time to time be amended.

I hereby authorize Maplewood Senior Living to conduct any necessary inquiries and collect any necessary information as to my character, reputation, and ability to perform in the position I am applying for, including but not limited to review of any personnel file maintained by my current or former employers and I release from any liability any and all former employers or educators, or personal or other references who supply Maplewood Senior Living with information about my background, education or employment history.

I understand that no offer of employment will be made until I have successfully completed all facets of the Maplewood Senior Living pre-employment screening process, which will include a criminal background investigation, screening test for illegal drugs and controlled substances and confirmation of my eligibility to legally work in the United States.

*Maplewood Senior Living is an equal opportunity company. We are dedicated to a policy of nondiscrimination in employment on any basis including age, ancestry, color, criminal record (in state employment & licensing only), gender identity or expression, genetic information, learning disability, marital status, mental disability, intellectual disability, national origin, physical disability, race, religious creed, sex, including pregnancy and sexual harassment and sexual orientation by state or federal law.

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