Additional Employer Information
Please Read Carefully and Check the Box Below
I herby authorize the investigation of all statements contained in the application. I certify that the information given on this application is true and complete, and I understand and agree that false statements, misrepresentations, or omission of requested facts is sufficient cause for dismissal from employment.
I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information the may have, personal or otherwise, and release all parties from all liability for any damages that may result from furnishing the same to you.
I understand and agree that if I am employed by Integ Health System P.C. (d/b/a The Eye Center of Southern Indiana, Bloomington Surgery Center), the employment relationship will be terminable at will at any time with or without cause by either party, notwithstanding any other oral or written statements by the Company prior to, at, or following date of employment, unless set out in writing, dated and executed by both parties. I understand that this application will be considered active for a period of six (6) months only.Insert and format text, links, and images here.