I certify that the answers given herein are true and complete to the best of my knowledge. I understand that, in the event of employment, false or misleading information given in my application or interview may result in discharge. I authorize investigation of all references and statements contained in the application for employment as may be necessary in
arriving at an employment decision. I understand that after meeting all other job prerequisites, and after I am offered a job, employment will be contingent upon
the satisfactory outcome of a medical examination. I understand that if I am offered employment, I will be working for Premier Home Health Care, on its payroll, at its client's
premises. I understand that Premier Home Health Care may terminate my employment at any time, without liability to me for wages and
salary except as have been earned by me at the date of such termination.