Employment Application

It is the policy of Assisted Living Services, Inc. not to discriminate against any individuals (including employee or applicant) because of race, color, age, religion, marital status, present or past history of mental, intellectual or physical disability, national origin, sex, gender identity or expression or veteran status. Assisted Living Services, Inc., will take affirmative action to ensure applicants are employed and that employees are treated during employment without regard to the above categories. This will include but will not be limited to employment, promotion, demotion, transfer, recruitment (including advertising), layoff or termination, compensation and selection for training. This policy is strictly enforced.

Please read the following statements carefully, as they represent matters of importance to both you and Assisted Living Services, Inc. (hereinafter “ALS”)

1. I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatements of fact, I am subject to disqualification, dismissal, or other action pursuant to employment agency policy and procedure, and subject to criminal penalties as prescribed by law.

2. ALS may verify all of the information that I have provided on this application. I release ALS and its representatives from liability for seeking such information and I release from all liability, all persons, institutions, business entities and corporations providing ALS with such information. I further agree to sign this application as consent necessary to permit ALS to verify all the information in this application.

3. In consideration of my employment, I agree to comply with policies, rules, regulations, and procedures of ALS and understand that my employment and compensation can be terminated with or without cause or notice, at any time, at the option of ALS.

4. I understand that ALS has spent considerable time, money and effort developing its client base as well as other proprietary information to which I will have access as an employee of ALS, including confidential medical and personal information concerning clients, their family members and representatives, and information concerning other employees of ALS. In consideration of my employment, I hereby covenant and agree not to solicit any employee of ALS (including management) to leave ALS’ employ, or solicit a client, family member or representative to terminate services with ALS. I also agree that I will not interfere with any ALS business relationships, including its relationships with clients, family members, representatives, referral sources and employees. I further covenant and agree that I will not divulge any customer lists, client or client representative information, or trade secrets to a subsequent homemaker-companion agency, or any other business organization in competition with ALS.

I recognize that any breach of this provision will result in irreparable harm to the legitimate business interests of ALS to retain clients, provide services, and to protect client information, employee information and trade secrets. As such, in the event that I breach this provision, ALS is entitled to seek injunctive relief, compensatory damages, punitive damages, attorneys’ fees, and costs associated with enforcing this provision. The terms of this provision shall remain in effect for a time period of one year following the termination of my employment with ALS and shall apply to the geographic area of the State of Connecticut.

I acknowledge that I have reviewed this Application Statement, understand these terms and that any questions have been answered to my satisfaction.