List three individuals, in addition to listed employment references, known to you for at least three years:

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsification or significant omission of information requested in this application or in the application process may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorize all persons listed above (and on the accompanying resume, if any) to give C-WHO any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and C-WHO, from liability for any damage that may result from furnishing same to C-WHO.

If employed by C-WHO I agree to abide by the policies and procedures of C-WHO and its client company, which include the C-WHO Anti-Harassment Policy. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of C-WHO, the client company or myself. I further understand that no manager or representative of C-WHO or its client company other than the president of C-WHO has any authority to enter into any agreement, oral or written, on behalf of C-WHO for a term of employment or to make any assurance or promise of continued employment.

DRUG TESTING: I understand and agree that, subject to applicable law, I may be required to take a drug and alcohol screening test. I also understand that if I test positive for the presence of drugs or alcohol, I may be ineligible for employment with the company.

BACKGROUND CHECK AUTHORIZATION AND DISCLOSURE: I understand and agree that C-WHO may obtain consumer reports and/or investigative consumer reports about me in connection with my application for employment, or if hired, at any time during my employment, in accordance with applicable laws.

These reports may include, but are not limited to:

• Consumer Reports: Such as driving records, criminal history, and other background checks conducted by consumer reporting agencies.

• Investigative Consumer Reports: Which may involve personal interviews and other means as permitted by law to gather information regarding my character, general reputation, personal characteristics, and lifestyle. These reports may also include information obtained from prior employers, business references, and personal references.

I understand that I may request, in writing, a disclosure detailing the nature and scope of any investigative consumer report obtained. I also acknowledge that I have access to a separate document entitled Summary of Your Rights under the Fair Credit Reporting Act at insperity.com/summary-of-rights-FCRA.