A criminal conviction will not necessarily be a bar to employment. To help us evaluate your application, please describe the nature of the crime and our rehabilitation.

I certify that the above information is true and complete and understand that employment is subject to satisfactory verification of this information. I agree that falsification of this document shall be grounds for termination. I agree that, if hired I will conform to the policies & procedures of Celadon Home. I hereby authorize Celadon Home to investigate my record with my former employers and release the Company and my former employers, and others providing information, from all liability whatsoever resulting from the disclosure of such information as long as the information is factual. I further understand and agree that my employment at Celadon Home is employment at will and may be terminated at any time by me or Celadon Home with or without advanced notice, with or without cause. As required by the Immigration Reform and Control Act of 1986, I am aware that: 1. Celadon Home hires only United States citizens or aliens authorized to work in the United States. 2. Celadon Home requires all new employees to complete a form verifying that they are eligible to work in the United States. 3. Celadon Home requires all new employees to show original documents which establish their identity and their eligibility to work in the United States.