Morning Star Hospice and Palliative Care

Employment Application

Choose today's date if currently employed

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application SHALL BE GROUNDS FOR DISMISSAL.

I Authorize complete investigation of all statements contained herein and herby give my full permission for Morning Star Hospice and Palliative Care Solutions to contact and fully discuss my background and history with all persons and entities listed above to give Morning Star Hospice and Palliative Care Solutions any and all information concerning my previous employment and any information they may have, and release all former employees and others listed above from all liability for any damage that my result from furnishing the same to the Morning Star Hospice and Palliative Care Solutions.

I understand and agree that, if hired, my employment is for no definite period arid may, regardless of the date of payment of my wages and salary, be terminated at any time for any lawful reason, without prior notice and with or without cause.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period shall inquire as to whether or not applications are accepted at that time.

I applicant hereby authorize Morning Star Hospice and Palliative Care Solutions to request and receive from all prior employees within one year of the date of this application, any and all pertinent information concerning my prior employment and its termination, including the reason for such termination.

DISCLAIMER

The applicant understands that this is an Equal Opportunity Employer who is committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.

Background Check Consent & Authorization

I (“Applicant”), hereby authorize Morning Star Hospice and Palliative Care Solutions (“Company/Organization”) and/or its designated agents to obtain and review background information for purposes related to my application for employment/contract work/volunteer service, or continuation of the same.

This authorization may include, when applicable:

• Pennsylvania State Police Criminal History Record Check (PATCH)

• Pennsylvania Child Abuse History Clearance (if required by role)

• FBI Criminal History Background Check (fingerprinting) (if required by role).

I understand that the background checks may be used to evaluate my suitability for the position and may be repeated if required by law, regulation, organizational policy, contract, or payer requirements.

I certify that the information I have provided is true, complete, and accurate to the best of my knowledge. I understand that any false, incomplete, or misleading information may result in denial of employment/assignment or termination.

Applicant Rights & Acknowledgement

I understand that I may request a copy of the results of any background check obtained, to the extent permitted by law. I also understand that certain roles (including those involving vulnerable populations) may require clearances as a condition of employment/engagement.