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EMPLOYEE DETAILS FORM

CONFIDENTIAL

Please note that all fields marked with an asterisk (*) are required.

EDUCATION AND TRAINING

PARTICULARS OF PREVIOUS APPOINTMENTS
(Beginning with last Employer)

I hereby declare that:

1. The particulars furnished above or in support of this application are true to my knowledge and belief and I have not knowingly withheld any information, which if disclosed, would affect my application unfavorably.

2. I shall be deemed to have been guilty of gross default/misconduct, in the event of my appointment with, if at any future date, Rockgarden Homecare Agency founds out that my declaration as above is false in any respect, and in that case, my services with the company will be liable to termination without any notice or payment in lieu of notice of any benefit or any compensation whatsoever.

3. In the event of my being selected for employment with Rockgarden Homecare Agency, I agree to abide by the rules and regulations applicable to the employees of the company which may be in force from time to time.

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