I hereby affirm that the information provided on this application form (and accompanying resume, if any) is true and complete to the best of my knowledge and agree to advice the General Manager of this property in writing, of any change or addition to any information contained in this application. I agree that false information or the omission of information from this Application (including leaving blanks on this Application or my failure to correct or add to the information changes during the course of my employment).

I authorize the investigation of my past employment and other qualifications of employment as deemed appropriate and agree to cooperate in such investigation. I agree to release, indemnify and hold harmless the Company from any and all liability in connection with its conducting such investigation as it deems appropriate and the use of the information received from third parties.

I further agree to promptly advise the General Manager of this property in writing, of any mental or physical condition, illness or contagious disease or condition that may cause me to present a risk of harm to the residents or staff of the property.

I consent to submit to such examinations and other health assessments requested by Baxter Senior Living. to determine my continuing qualifications to perform the essential responsibilities of any position I may have to be considered for by Baxter Senior Living.. I also agree to the release of copies of all health information requested by Baxter Senior Living. which is or may be related to my qualifications to work.

I understand that if I am hired, my employment with Baxter Senior Living. may be terminated, with or without case, at any time at the discretion of either Company or myself. I understand that, if I am accepted for employment with Baxter Senior Living., the Company reserves the right to change my job responsibilities, wages, benefits and any other term or condition of my employment with Baxter Senior Living. at any time to meet the needs of Baxter Senior Living.

I understand and agree that, at the time my voluntary or involuntary termination from employment with Baxter Senior Living, I am entitled to the wages I earned as of the last day I worked for Baxter Senior Living. I hereby agree that any amounts I owe to Baxter Senior Living at that time may be set off and applied against the wages owed to me at the time of termination.

I further understand and agree that this is an application for employment and that no employment is being offered by this application.