The statements I have made on this application are true to the best of my knowledge, accurate and complete. I understand that it is my responsibility to include the necessary materials in my application packet and to inform the Agency of any change in my application including name, address or phone number changed.

I further understand that I release Afro Care HCA from all liability for damages of whatever kind, which result due to compliance with the request for information. Any misrepresentation or willful omissions of facts shall be sufficient cause for disqualification of this application or termination of employment.

I have read, understand and agree to the above statements