List below the names of all employers ( you may list volunteer positions as well as paid positions, if you wish). List present employer or most recent employer first.

Provide the following information regarding 3 persons not related to you who have known you longer than 1 year (preferably work-related.)

(Please read the following statements carefully). I understand and agree that prior to any job offer, I will be given a written description of that job and will be asked about my ability to perform specific job functions or duties involved in that job. I certify that all information on this application and any other material provided by me are true and complete. I agree that falsified information, misrepresentation, or omissions in this application, or any accompanying resume or other materials will disqualify me from consideration for employment with the Quaboag Rehabilitation & Skilled Care Center and will be considered justification for dismissal whenever discovered. Unless otherwise noted, I authorize The Quaboag Rehabilitation & Skilled Care Center or its agents to investigate and/or verify all information in this application, including contacting persons, schools, current employer (if applicable), previous employers, and other individuals or entities named herein (and those named on accompanying resume, if any.) I hereby authorize my former employer and other third parties named on this application to release information pertaining to my work record, habits, and performances. In doing so, I hereby release them and the Quaboag on the Common Rehabilitation & Skilled Care Center and its agents from all liability which may flow from the release of such information. I understand that if I am hired my employment will be on an at-will basis, for no definite term. As such, I understand that I will enjoy the right to terminate my employment at anytime, and that Quaboag Rehabilitation & Skilled Care Center will similarly enjoy the right to terminate my employment, at any time, with or without cause. This status can only be modified by a written document setting forth such modification, signed by both me and an authorized representative of Quaboag Rehabilitation & Skilled Care Center. I further acknowledge that I am expected to abide by all Company rules, regulations and policies, written or unwritten, but that such rules, regulations and policies do not create a contract between me and the Company or otherwise restrict the right of either party to terminate the employment relationship.