By submitting this application to Revere Health, I certify that all information is true, complete and correct.

I authorize the employer, its representatives, employees or agents to contact and obtain information from all references,
employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all
information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have
regarding employer, its agents, employee or representative, for seeking, gathering and using truthful and non-defamatory
information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing
such information about me.

I understand that this employer does not unlawfully discriminate in employment and no questions on this application are used for
that purpose.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the
employer and still wish to be considered for employment, it will be necessary to complete a new application.

I understand that if I am hired, that I will be required to provide proof of identity and legal authorization to work in the United
States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be
sufficient cause to eliminate me from further consideration for employment or may result in my immediate discharge from the
employer’s service, when ever it is discovered.