3Care4U

P.O. Box 1312 Manitowoc, WI 54220 | 920-663-1225 | [email protected]

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Age: 16-20 21-40 41-50 51 & Older

Gender: Male Female

Race: White | Asian | Black | Hispanic

Disable: Under the American with Disabilities Act with respect to an individual, the term disability means: a person who has a physical or mental impairment that substantially limits one or more life activity; has a record of such impairment; or is regarded as having such an impairment. "Substantially limiting" means the degree that impairment affects employability. "Disabled Individual" does not include an alcohol or drug abuser whose current use of alcohol or drugs renders that individual a hazard to the individual or others. If you have disability requiring special accommodations, please explain:

PLEASE READ BEFORE SIGNING
I authorize 3Care4U to investigate all statements contained in this application, and I authorize my previous employer(s) to release any information requested by 3Care4U. I understand and agree that any false or misleading information provided on this application may result in termination of employment, if I am hired. I understand that no promise or guarantee of employment has been made to me, and that nothing contained in this application, the granting of an interview, or any policies, procedures, or handbooks I may receive is intended to create an employment contract or to entitle me to any rights of employment with 3Care4U. 3Care4U does not discriminate against or harass any employee or applicant for employment on the basis of race, color, creed, religion, national origin, sex, sexual orientation, disability, age, or marital status. By signing below, I certify that I have read and fully understand the above information and that all statements I have made are true and complete to the best of my knowledge. I agree to be fully liable and to indemnify 3Care4U for any damages, including costs and attorney’s fees, resulting in whole or in part from any false or misleading statements I have made.