I certify that the information provided on this application is truthful and accurate. I
understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize LIEM Hospice, Inc. to contact former employers and
educational organizations regarding my employment and education. I authorize my former employers and educational organizations to communicate pertinent
information. I authorize those persons designated as references to communicate information fully and freely regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a
specific written contract of employment signed on behalf of the organization by its Administrator or hiring manager, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice.

Similarly, my employer will have the right. Moreover, no agent, representative, or
employee of LIEM Hospice, Inc., except in a specific written contract employment signed on behalf of the organization by its Administrator or hiring manager, has the power to alter or vary the voluntary nature of the employment relationship.