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APPLICATION ACKNOWLEDGEMENT AND AGREEMENT

APPLICANT’S ACKNOWLEDGEMENT AND AGREEMENT

PLEASE READ CAREFULLY:

  1. CERTIFICATION OF TRUTHFULNESS

The information contained in this application is accurate and complete to the best of my knowledge and belief. I understand that this application must be fully and accurately completed, without omission and without evasion.  I also understand that any misrepresentation of fact, as stated or implied, given in my application, interviews, or any other employment form or document provided to Hart Medical Equipment L.L.C. (“Hart”), is sufficient reason not to hire me, or reason for dismissal if discovered during my employment. I also acknowledge that this application will only be considered for the first ninety (90) days after I apply. If I desire a position after this application expires, it will be my responsibility to fill out a new application and file it with Hart.

  1. AUTHORIZATION FOR EMPLOYMENT/EDUCATION INFORMATION

I understand and agree that all information furnished in this application, including references, prior employment and education, may be investigated by Hart and/or its authorized agents, and I authorize Hart and its authorized agents to obtain additional background information, including but not limited to one or more consumer reports. I understand that any offer of employment is conditional based upon my successful completion of a background check and that any falsification or withholding of information may be grounds for withdrawing an offer of employment. I waive the right I may have to notice from any individuals or organizations named or referred to in this application prior to the release of any employment information to Hart. I hereby authorize all individuals and organizations named or referred to in this application and any law enforcement organization or credit reporting agency to give Hart all information that relates to or is requested during Hart’s investigation, and I hereby release those individuals, organizations and Hart from any and all liability for any claim or damage resulting therefrom.  Further, following the separation of my employment from Hart for any reason, I authorize Hart to use and/or disclose any information in its possession concerning me for reference or other purposes to any third party without receiving any prior notice, and I waive all Claims (defined below) in connection with such use and/or disclosure.

  1. HART RULES, POLICIES, PROCEDURES AND STANDARDS

I understand that, if hired, I am required to abide by all rules, policies, procedures and standards of Hart including, without limitation, those set forth in an Employee Handbook, as may be amended from time to time, or in any other communication to employees. I further understand that Hart’s rules, policies, procedures and standards are subject to change without prior notice.

  1. ANY EMPLOYMENT IS AT-WILL

I understand and agree that, if hired, my employment will be at-will, and either I or Hart may terminate my employment at any time, with or without cause and with or without notice.  I understand and agree to the full extent provided by applicable law that no one at Hart has any authority to change this at-will arrangement except for the President of Hart, who may only do so in a written signed agreement. 

  1. PHYSICAL/MEDICAL EXAMINATION AND DRUG/ALCOHOL TEST

I consent to drug and alcohol testing as directed by Hart and understand that if I do not successfully complete the test that any job offer will be withdrawn.  I further understand and agree that if I am employed, I may be required to submit to alcohol or drug testing, random or otherwise, during my employment.

  1. REQUEST FOR ACCOMMODATION

If I am a qualified individual with a disability or disabilities who requires a reasonable accommodation to perform my job and I work in Michigan, I agree that I must notify Hart of my need for the same within 182 days after I know or reasonably should have known that an accommodation was needed.  Failure to do so will bar me from alleging that Hart has not accommodated me under applicable law.

  1. SHORTENED PERIOD FOR FILING CLAIMS/APPLICABLE LAW

I understand and agree that any and all causes of action, lawsuits, damages, claims, and/or demands whatsoever relating to Hart, its affiliates, any successors, and/or involving any of their respective shareholders, owners, officers, directors, employees, agents, and/or representatives arising out of the employment application process, my employment and/or separation of employment including but not limited to those arising under any State or Federal civil rights statutes and those seeking collective or class relief (collectively, “Claims”) must be brought, if at all, within six (6) months of the event or events from which the Claims arise but in no event more than six (6) months following the separation of my employment with Hart (or within the time frame provided by any shorter statute of limitations), or the Claims will be forever barred to the full extent permitted by applicable law.  I waive any statutes of limitations to the contrary.  Applicable law means Michigan law, regardless of any other conflict of law principles.  

 

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