Disclaimer and Signature

By typing your signature, you hereby certify that your answers are true and complete to the best of your knowledge. If this application leads to employment, you understand that false or misleading information in your application or interview may result in your release. Completing this application does not confirm employment. 

Furthermore, you authorize Gold Medal Home Health and/or its agents to make an independent investigation of your background, references, character, past employment, credit history, adult criminal or police records, and motor vehicle records including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained in your application and/or obtaining other information which may be material to your qualifications for service now and, if applicable, during the tenure of your employment or service with Gold Medal Home Health.  You release Gold Medal Home Health and its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims or lawsuits in regard to the information obtained from any and all of the above referenced sources used.

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