The information provided in this application for employment is true, correct and complete. If employed, any
misstatement or omission of fact on this application may result in dismissal.
In consideration of my employment, I agree to conform to the rules and regulations of Pediatric Complex Care of Arkansas and
further agree that my employment and compensation are at the will of PCCA and can be terminated with or
without cause and with or without notice, at any time, at the option of either myself or PCCA. I understand and
agree that these terms can be modified by the Administrator. No supervisor, representative, agent, or employee of PCCA has now or has had in the past any authority to enter into any agreement of employment for any specific period
of time, or to make any agreement which is contrary to or modification of the above terms, nor can any policies or
practices of PCCA either written or oral, modify the above terms.
Should the information obtained from Arkansas Child Abuse and Neglect Registry, State or Federal background check
contain documentation of substantiated abuse or neglect of a minor, or any of the 61 offenses listed by the Office of
Long Term Care as prohibited by an employee, I understand my employment with Pediatric Complex Care of Arkansas will be
I hereby authorize all educational institutions which I have attended, all branches of U.S. military service in which I have
served, all of my former and current employers, and all of their representatives to furnish to Pediatric Complex Care of Arkansas
or its representatives any and all information concerning my education, military services, and/or former/current
employment. In addition, I hereby agree to hold harmless and to release all of said educational institutions, military
services, employers and representatives from any and all claims that I may have, or which may arise against any and/or
all of them, including Pediatric Complex Care of Arkansas, as a result of their furnishing information to Pediatric Complex Care of Arkansas.