EMPLOYMENT

Allure In-Home Health Services, LLC 

can employ no applicant until they pass a screening of the Employee Disqualifications List (EDL) and until Allure In-Home Health Services, LLC has obtained a clean background check on the application from the Family Care Safety Registry (FCSR). If an applicant has certain offenses listed on the FCSR background check, the applicant may apply for a "Good Cause Waiver" to the Missouri Department of Health and Senior Services (DHSS). DHSS may grant (approve) a "Good Cause Waiver" at their discretion. Allure In-Home Health Services, LLC will not, under any circumstances, employ anyone listed on the EDL. The FCSR will be checked twice a year. The EDL will be checked four times a year (this included the checks done through the FCSR). If any new listings appear on either of these background checks, the attendant will no longer be able to be employed by Allure In-Home Health Services, LLC. The employee will receive a copy of the background check from DHSS (FCSR) at least twice a year. This simply means that the Allure In-Home Health Services, LLC has requested an updated copy of the attendant's background check for our records. I certify by my signature that the information I have provided on this form is true and complete to the best of my knowledge.

I, authorize Allure In-Home Health Services, LLC to run a pre-employment criminalbackground check through the State of Missouri, Employment Disqualification List (EDL), Family Care Safety Registry(FCSR) which obtains information from the Missouri Highway Patrol, Missouri Department of Social Services (ChildAbuse/Neglect records and Foster Parent records), Missouri Department of Health and Senior Services (EDL and ChildCare Facility Licensing records) Child Care Facility Licensing records.

I, understand that if the Employee Disqualification List (EDL) results show that Ihave been found on the list, I will not be hired by ALLURE IN-HOME HEALTH SERVICES, LLC at any time.

I, also understand that until MO DHSS has verified that they have received myGood Cause Waiver and supporting documentation, I cannot be employed by ALLURE IN-HOME HEALTHSERVICES, LLC. Once MO DHSS sends receipt of Good Cause Waiver application, it will be at the discretion ofALLURE IN-HOME HEALTH SERVICES, LLC to offer conditional employment.

I. understand that if MO DHSS denies my Good Cause Waiver application/request,my conditional employment will be immediately terminated by ALLURE IN-HOME HEALTH SERVICES, LLC.

I, also understand that until MO DHSS has verified that they have received myGood Cause Waiver and supporting documentation, I cannot be employed by ALLURE IN-HOME HEALTHSERVICES, LLC. Once MO DHSS sends receipt of Good Cause Waiver application, it will be at the discretion ofALLURE IN-HOME HEALTH SERVICES, LLC to offer conditional employment.

I, understand that ALLURE IN-HOME HEALTH SERVICES, LLC will verify mystatus of licensing through the online verification source. This online system will provide information pertaining to mycurrent status of active or inactive licensing.

I, understand that ALLURE IN-HOME HEALTH SERVICES, LLC will verify myavailability to seek employment within the United States. I will provide all necessary documentation (Valid driver'slicense and social security card) and any additional information to support my authorization to work within the UnitedStates.