Personal Care/ADLs

Vital Signs

Transfer Techniques

Elimination

Care Experience

I authorize any insurance company, employer, educational institution, law enforcement organization, state or federal government agency, information service bureau, medical facility or practitioner, and any other person or organizations listed on this application to release information regarding my character, performance, qualifications, background, reasons for termination of past employment, and eligibility for rehire to PNPS, Inc. I also authorize a complete background check including, but not limited to, criminal records, social security number verification and driving record. I also authorize the release of my driving records and criminal records, and understand that it may contain information about my background, mode of living, character, and personal reputation. I understand that a criminal conviction is not an automatic bar from employment and will be reviewed for job related impact. I authorize you to request and receive such information and release you and all parties involved in providing such information from any responsibility or liability. I understand that the decision to hire is solely that of Professional Nursing Placement Service, Inc.As part of my employment with the Company, I agree that all information which I receive in the course of my employment relating in any manner to, among other things, the business activities, customers, production processes, financial affairs, programs, concepts or designs of PNPS, Inc. are to be treated by me as trade secrets and kept in confidence, not to be disclosed to any unauthorized person either during or after my employment, or used by me in any manner adverse to the interests of PNPS, Inc. I may be required to sign a separate Confidentiality Agreement.

In consideration for my employment by your Company, I agree to conform to the rules of the Company and acknowledge that these rules and regulations may be changed, interested, suspended, withdrawn, or added to by your Company at any time, at the Company's sole option and without any prior notice to me.

I further acknowledge that my employment is at-will and may be terminated, and any offer of employment, if such is made, or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause, and with or without prior notice, at any time, at the option of the Company or myself. I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between PNPS, Inc. and myself for either employment or for providing of any benefit.

If my services terminate after accepting employment, I understand that the PNPS, Inc may supply, in confidence, my employment record to any prospective employer, with no liability to the Company or its staff.