I certify that all answers given by me are true, accurate and complete.
I authorize investigation of all statements contained in this application, providing a urine sample for a drug test and for a background check to be completed. I understand that misrepresentation or omission of facts in this application may be cause for invalidating my contract referral agreement with Love Right Home Care Referral Agency.
I hereby release any and all prior employers or current employers from liability or claims arising out of the provision of information about my employment with such employer. I hereby waive any cause of action I might otherwise have against such employer arising out of provision of information concerning my employment.