It is understood and agreed that any agreement entered into between Company and the prospect is predicated upon the truthfulness of statements in this report. I hereby authorize and request any and all of my former employers and others, unless otherwise indicated, to furnish a complete history of my services with them, together with any information they may have concerning my personal character, habits, ability, disposition, etc. and particularly a statement of the cause of termination of my employment. I hereby release them from any and all liability for damages of whatsoever nature as a result of furnishing the requested information.
This is to inform you that, as part of our procedure for processing your application, an investigative report may be made whereby information is obtained through personal interviews with third parties, such as family members, business associates, financial sources, friends, neighbors, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living, whichever may be applicable. You have the right to make written request, within a reasonable period of time, for a complete and accurate disclosure of additional information concerning the nature and scope of the investigation.
The above information is true to the best of my knowledge and belief, and is submitted in support of my seeking approval for an Interim Healthcare Inc. franchise.