CONFIDENTIALITY STATEMENT Disclosure of confidential information gained through your employment by Clare Senior Care AFC & GAFC LLC, is stated as an act of prohibited conduct subject to formal disciplinary action. Any information concerning a patient’s illness, family, financial condition or personal peculiarities is strictly confidential. When a patient’s history or condition is reviewed, it must be done in privacy with only those persons involved with the care of the patient. Any other information coming to you in the course of your work concerning another person or employee is also considered confidential and may not become the topic of conversation with others. *

Yes (AFC Caregivers are "considered our staff"

APPLICANT’S STATEMENT I understand and agree that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer’s service if I have been employed. Furthermore, I understand that this is an “At Will employment” and just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of the employer has the authority to make assurances to the contrary. I give the employer the right to investigate all references and to secure additional information about me, if job-related. I hereby release from liability the employer and its representatives for seeking such information, and all other persons, corporations, or organizations for furnishing such information.

The undersigned, having applied for a position with our company, hereby authorize you to release any information necessary relating to employment. This hereby releases your organization unconditionally from all liability for damage whatsoever that might result from furnishing this information. I acknowledge applying with Clare Senior Care AFC & GAFC LLC, and authorize the release of information from my former employer.