Employment Application Form

I hereby, certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material facts on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby, authorize Royalty Ambulance Services, Inc. to thoroughly investigate my references, work records, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to Royalty Ambulance Services, Inc. all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Royalty Ambulance Services, Inc., my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I hereby agree to submit to mediation all disputes and claims arising out of the submission of this application. In addition, should mediation fail, I then agree to submit any such claims to binding arbitration and to waive any and all jury trial or class or collective action as is set out below. If hired by this company, I agree that all disputes that cannot be resolved by informal internal resolution, or then by mediation, which might arise out of my employment with the company whether during or after that employment, will be submitted to binding arbitration. I agree that I will waive all rights to jury trial. I agree that all claims subject to this Agreement must be pursued on an individual basis only. By initialing here, I agree to waive my right to commence, or be a party to, any class, collective or representative action or to bring jointly or collectively any claim. I shall have an unfettered right to opt-out of this class action waiver as stated in this part within 30 days of my agreement to accept it, and should I opt-out, said provision shall not be applicable to me. However, such an opt-out decision must be in writing and presented to the HR department or some other management personnel.

I understand that nothing contained in the application, or conveyed during any interview, which may be granted or during my employment, if hired, is intended to create an employment contract between me and Royalty Ambulance Services, Inc. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Royalty Ambulance Services, Inc., and that no promises or representations contrary to the foregoing are binding on the Royalty Ambulance Services, Inc. unless made in writing and signed by Royalty Ambulance Services, Inc. designated representative.