I fully understand that any significant misstatements in or omissions from this application
constitute cause for denial of employment or cause for dismissal from employment. All
information submitted by me in this application is true to my best knowledge and belief.
I hereby authorize an inquiry to be made on the information contained in the application, and
authorize any individual contacted during this inquiry to give you any and all information
concerning my previous employment and any pertinent information they may have, personal or
otherwise, and release all parties from all liability for any damage that may result from
If an employment agreement is established, I agree to conform to all the rules and regulations
this Center and I understand that my employment and compensation can be terminated, with or
cause, and with or without notice, at any time, at the option of the Center.
Thank you for your interest in joining our team at the Outpatient Surgery Center of