THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, AND ALL STATEMENTS BELOW HAVE BEEN READ AND ACKNOWLEDGED. 1. I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered. 2. I recognize that this employment application is not an offer of employment. I agree that if I am hired by Home Care Assistance of Missouri, LLC (HCA), I will be an at-will employee, meaning that either HCA or I may end the employment relationship at any time with or without cause or notice. I understand that only an executive officer of Home Care Assistance of Missouri, LLC and no manager, supervisor, or other representative of HCA, has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship. 3. I further understand and agree that, except for my at-will employment status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change. 4. I understand that if I am offered employment, I may be required to sign a non-solicitation and non-disclosure agreement, as a condition of the employment. 5. I understand that HCA may share the information contained in this application with other HCA employees for employment and administrative purposes and hereby consent to such transfer. 6. I hereby authorize, to the extent allowed by applicable federal state and local laws, HCA to conduct its own investigation of my references, employment history and education and, further, authorize the references and prior employers I have listed to disclose to HCA information related to my employment history and qualifications for the position for which I am applying, without giving me prior notice of such disclosure. In addition, I hereby release HCA, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. 7. I understand and expressly agree that if employed by HCA, storage areas provided for me (locker, desk, etc.) are open to investigation by HCA without prior notice to me. 8. I agree to submit to legally permissible drug testing upon an offer of employment from HCA and prior to starting work. I agree that any offer of employment is contingent upon my receiving a negative test result. 9. I understand that HCA, has an arbitration procedure governed by the Federal Arbitration Act, 9 U.S.C. sections 1 et seq. The arbitration procedure applies to claims brought by me against HCA or by HCA against me. I agree that any claim arising out of or relating to the application process, including, without limitation, a claim alleging unlawful discrimination and/or harassment, and any claim arising out of or relating to my employment or its termination (if I am offered and accept employment), including, without limitation, a claim of unfair business practices, unlawful employment discrimination, harassment, wrongful demotion and/or wrongful termination, will be presented to a neutral arbitrator for final and binding decision in accordance with procedures adopted by HCA. These procedures do not prevent me from filing a claim or charge with the Equal Employment Opportunity Commission, U.S. Department of Labor or National Labor Relations Board. Nor do these procedures prevent me from making a claim for workers’ compensation or state disability benefits or unemployment insurance. I understand and agree that I may review HCA's arbitration procedures before submitting this application for employment by making a written request for a copy of those procedures from HCA. This agreement is a waiver of all rights to civil court actions for a claim subject to arbitration. Only the arbitrator, not a judge or jury, will decide the claim or dispute. APPLICANT’S STATEMENT & ACKNOWLEDGMENT. My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between HCA and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between HCA and me on such issues. This application will only be considered for 30 days. If you have not been hired within 30 days of submitting this application and you wish to continue to be considered for employment, you must complete another application.