I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or mission of facts, represents grounds for elimination form consideration for employment, or termination after employment if discovered at a later date. I authorize GENUINE HOME CARE AGENCY to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document in NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contact for continued guaranteed employment. I understand that employees of GENUINE HOME CARE AGENCY serve at-will, and the employment relationship may be terminated at any time by either party, or any no reason, other than a reason prohibited my law. If employed, I will be required to furnish proof of eligibility to work in the United States and to comply with agency regulations. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I would now be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.