Please read and accept the following agreement.
CERTIFICATION OF APPLICANT: I authorize Creative Community Living Services, Inc. (CCLS), (CLE) & (Magnolia Hill) to make any inquiry of or receive
information from any person or organization regarding my suitability for employment; and do hereby give permission to these persons or
organizations to provide such information. Such inquires may include and not be limited by enumeration to the quality and quantity of my work,
work history, and record, character, qualification, records of convictions and medical records. For and in consideration of the release of
such information, I hereby forever waive, release and covenant not to sue any person or organization including CCLS, its agents and employees
for the result of providing, obtaining, or acting upon such information. I give this waiver, release and covenant not to sue understanding that
the information obtained may be such as to disqualify me for employment. I understand that such information is sought with confidentiality, and
I will not request copies of such information. I also certify that all statements made on this application are true and complete, accurate and
not misleading to the best of my knowledge. I understand that false statements, incomplete statements, omissions, or misrepresentations may
subject me to disqualification or dismissal. A copy of this authorization shall be as effective as the original.