Carefully Read This Section Prior To Providing Signature Below

            I consent to any medical examination required by the facility at any time to determine my ability to perform the duties of my job or other jobs with the facility and I understand that my employment may be conditioned upon satisfactorily passing a physical examination.  I understand that I may be required to satisfactorily complete an alcohol/drug screening as a condition of employment.

            I understand that my employment can be terminated at any time and for any reason at the option of either the facility or myself.  I understand that no one has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing except for a written employment agreement signed by an administrative representative of this facility.

            I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete.  I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment, and may result in discharge even if discovered at a later date.

            I hereby authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume, if any) to provide this facility and all affiliates with any relevant information regarding an employment decision, and I release all such persons from any liability regarding the provision or use of such information.