Personal Information

Personal Information

Military Service

Education

Education

High School

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College

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Other Schooling

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Previous Employment

Previous Employment Please give an accurate, complete full-time and part-time employment record. Start with your present or most recent employer.

Company 1

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Company 2

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Company 3

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Additional Information

Additional Information

Applicant's Statement

Applicant's Statement

Please read and understand this statement before signing your application:

The information I have provided in this Application for Employment is true, correct and complete. False, incomplete or misrepresented information of any kind, will be sufficient cause for my application to be rejected or, if discovered after I am employed, cause for immediate termination of my employment. This application for employment shall be considered active for a period of time not to exceed 45 days. After that date, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application.

I authorize Physicians Surgery Center to contact and obtain information about me from previous employers, educational institutions and "references" I have provided, and any other party necessary to verify the accuracy of information I have disclosed in this application, a related employment resume or a personal interview. I authorize Physicians Surgery Center, to perform a background investigation on myself. I have disclosed any criminal convictions or any civil monetary penalties assessed against as previously asked in this application. To assist in the processing of my application, I waive all rights and claims I may otherwise have against the employer or its representatives, for seeking, and using information to evaluate my employment request and all other persons, corporations or organizations who provide information for this purpose.

I hereby understand and acknowledge that, this application is not an employment agreement, and unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.