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(Verification of your legal right to work in the United States will be required within three days of being hired.)

I certify that all information provided on this application is true and accurate. I understand that any false statements, misrepresentation, or omissions made on this application will exclude me from consideration for employment or subject me to discipline up to and including termination from Health Services Management Inc. I understand that employment with Health Services Management Inc. is “at will” and therefore for an indefinite period of time. If employed, I may terminate my employment at any time and the Employer may terminate or modify the employment relationship at any time with or without notice or cause. I understand that I am not guaranteed a specific shift, schedule or work assignment and I may be expected to work overtime. If employed by Health Services Management Inc. I will abide by its rules, regulations, policies and procedures. I hereby authorize all individuals and organizations named or referred to on this application to answer all questions that may be asked and give all information that may be sought in connection with this application. This may include, but is not limited to: work history, criminal records, licensure, certification, education, and driving record. I also certify that any individual or organization furnishing information concerning me shall not be held accountable for giving this information. I hereby release said individuals and organizations from any and all liability, which may be incurred as a result of furnishing such information. I understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate termination of employment. Finally, I freely and voluntarily agree to undergo drug testing as part of the application process, or at any time during my employment with Health Services Management Inc. I understand that either refusal to submit to the test or failure of the test per Health Services Management Inc. policy will disqualify me from consideration and/or continuation of employment.