75 Executive Drive, Suite 305 Aurora, Illinois 60504

ACE Application for Employment

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Please type N/A for all fields that do not apply.

CONVICTION WILL NOT NECESSARILY BE A DISQUALIFICATION FOR EMPLOYMENT

EDUCATIONAL BACKGROUND

List previous four (4) educational institutions attended, beginning with the most recent. Include high school, college, business or trade school and professional school.

What Nursing, Professional or relevant designations, licenses or registrations if any, do you possess?

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Do you have training in the following:

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Please Answer the Following Questions

EMPLOYMENT BACKGROUND

Provide the following information beginning with the most recent employer.

Month/Year

Month/Year

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Month/Year

Month/Year

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Month/Year

Month/Year

References

List the name, relationship, number of years acquainted, and phone number of three references. (No relatives please).

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I certify that all the information I have provided is true, complete and correct. The information contained within this application or any cover letter or resume attached is not shared with any third parties. The information is used by the employer only as an aid in the hiring decision making process. The applicant, by signing the application gives the employer consent to collect the information contained herein and use for the purpose specified. I authorize Keyes2Life, Inc. to investigate all statements contained on this application. I understand that any misrepresentation or omission of facts called for is cause for immediate disqualification and/or if employed, immediate dismissal. I understand that if I am hired, I will be required to provide criminal background check at my cost, proof of identity and legal authority to work in the USA, proof of certifications or educational qualifications, and a driver’s record (if applicable). I understand that, in connection with the routine processing of your employment application, Keyes2Life, Inc. may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, Keyes2Life, Inc., will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with Keyes2Life, Inc. shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with Keyes2Life, Inc. is terminable at will for any reason by either party. If employed, I understand that Keyes2Life, Inc. may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. This application does not in any way constitute an agreement or contract for employment.

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Keyes2Life, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Keyes2Life, Inc. depends solely on your qualifications.