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 The Eye Clinic P.C. 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 The Eye Clinic P.C., 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.
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