PLEASE READ PRIOR TO COMPLETING AND SIGNING THIS APPLICATION.

1. This company is an equal employment opportunity employer and does not discriminate because of age, sex, race, creed, color, national origin, disability, sexual orientation, citizenship status, or religious preference.

2. Proof of employment eligibility for compliance with the United States Immigration Control and Reform Act of 1986 is required prior to employment.

3. I understand that, if the position applied for requires frequent driving, I must comply with certain automobile liability insurance requirements and provide proof of insurance, if hired.

4. All positions require a criminal records check.

5. Documentation of required credentials must be received prior to final interview.

6. I hereby authorize and request any and all of my former employers to furnish any and all information concerning my job performance. I agree to hold my former employers and their agents harmless from all liability which could relate in any way to the disclosure of private information or an assessment or opinion of my suitability for employment.

7. I have read and understand the job description. I have no physical or mental requirements or limitations which might affect my ability to perform the job.

8. I understand that misrepresentation or omission of facts herein is cause for termination, if I am hired.

9. I understand that, if hired, I will be required to: 1) Sign a Confidentiality Agreement, requiring me to refrain from disclosing client or research participation information, and 2) Complete required HIPAA training.

10. I have read and understand this application and have answered all portions of this application truthfully and correctly, with no omissions.

This application is valid for 90 days.