Cardinal Ritter Senior Services offers equal employment opportunities to all persons. It avoids discrimination either in the hiring process or in employment opportunities on the basis of race, color, ancestry, disability, age, sex, national origin, citizenship, military status, veteran status, or any other category protected by federal, state or local law.

List below your previous employers, listing your current or last employer first. If more than four, please list them on a separate page or include your resume. Please explain any lapses between times when employed. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.

A "YES" response to either of the two preceding questions will not necessarily disqualify you from consideration for employment with CRSS. A record of a conviction, or a refusal by a surety company to issue or continue a bond on your behalf, does not necessarily mean that you cannot be hired. The nature and circumstances of any conviction or bond refusal, how long ago either occurred, and other factors, including the relationship of the conviction or bond refusal to the position for which you are applying, are all important considerations in the employment decision. Thus, please provide a complete response to these questions so that an appropriate decision may be made.

If yes, please complete the following questions:

A "YES" response to any of the above three questions will not necessarily disqualify you from consideration for employment. The nature and circumstances of the matters reported as well as their disposition are all important in the employment decisions.

Cardinal Ritter Senior Services does not discriminate on the basis of handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs and activities.

The person named below has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s regulations implementing Section 504 (24 CFR Part 8 dated June 2, 1988).

NAME OF COORDINATOR: Human Resources Director ADDRESS: 7601 Watson Rd. St. Louis, MO 63119 TELEPHONE #: 314-961-8000 Fax#: 314-961-1934

I grant permission to Cardinal Ritter Senior Services (CRSS), to thoroughly investigate my complete personal, educational and work histories and to verify all information that may be given in connection with my seeking of employment with CRSS. I also grant permission to CRSS to contact, in connection with my application and periodically thereafter if I am employed, the Missouri Department of Social Services and any other governmental agencies, organizations, corporations, entities or individuals that CRSS deems necessary in order to verify the combined accuracy of any information given in connection with this application. I agree to complete, in connection with my application and periodically thereafter if I am employed, any and all forms required by CRSS (including, but not limited to an application for patient or resident abuse or neglect screening form to be submitted to the Missouri Department of Social Services). In addition, I release CRSS and its agents from liability for any acts or omissions occurring during either such investigation or verification, or both. I further release any one or more individuals, organizations and their agents, educational institutions that I attended and their agents, or my former employers and their agents from any liability for any acts or omissions occurring in its or their responses to the inquiries of CRSS about me. I understand and agree that I may be denied employment or, if I am already employed, that my employment may be terminated based on information obtained during that investigation or verification. Upon the termination of my employment with CRSS, regardless of when, how or why my employment is terminated and regardless of whether CRSS or I terminate it, I authorize the release of information on all aspects of my employment history with CRSS and release CRSS and all of its agents from any and all liability resulting from the disclosure of information on my employment history.

In addition, I understand and agree that this application will be considered valid for a period of sixty (60) days. I recognize that, if I wish to be considered for employment after sixty(60) days, I must complete a new application for employment.

Moreover, if I am offered employment by CRSS, I understand and agree that my employment will be based upon mutual agreement and that either CRSS or I may terminate my employment at any time and for any reason. I understand that no supervisor, agent or representative of CRSS, other than the Administrator, has any authority to enter into any written employment agreement with me for any period of time, or to make any written agreement contrary to the foregoing. I further understand that no supervisor, agent or representative of CRSS, including its Administrator, has any authority to enter into any oral employment agreement with me for any period of time, or to make any oral agreement contrary to the foregoing. In consideration of my employment, I agree to conform to the rules and regulations of CRSS.

Finally, I certify that I have given true and accurate information and that I have read and agreed to the conditions of employment stated in this application and authorize the release as set forth above. If any information contained in this application is found, in the opinion of CRSS, to be false in any respect, my application for employment may be rejected. Similarly, if I am already employed, I will be subject to discharge without notice at any time.