Yes
No
Yes
No
Yes
No
Yes
No

Education

Yes
No
Yes
No
Yes
No

References




Previous Employment

Yes
No

Yes
No

Yes
No

Military Service


Disclaimer and Signature


I certify that the information contained in this application is true and correct and complete to the best of my knowledge and belief. I understand that any false statement, omission, or misrepresentation of facts in connections with this application can be cause for rejection of my application, or if I am employed, for my dismissal from employment. I also understand that I am required to abide by all rules and regulations of Resurgence Healthcare Solutions, LLC. , and that I may be asked to work overtime hours or hours outside a normally defined work day or week. I hereby authorize investigation of all information contained in this application for employment as well as all information otherwise submitted by me orally or in writing, in connection with my application for employment. In this regard, I authorize Resurgence Healthcare Solutions, LLC. , to request and obtain information concerning my previous employment and educational background from all of my prior employers and educational institutions which I have attended, information concerning me. I hereby authorize any prior employer or educational institutions which I have attended, to provide information to Resurgence Healthcare Solutions, LLC. , as may be requested, and I hereby release them and each of them from any and all liability for damages of whatever nature arising from furnishing the requested information. I hereby understand and acknowledge that if I am employed, my employment relationship with Resurgence Healthcare Solutions, LLC. , is of an "at-will" nature, which means that I may resign at any time and that Resurgence Healthcare Solutions, LLC., may discharge me at any time, with or without cause. It is further understood that this "at-will" employment relationship may not be changed by any statement or conduct of any person, unless such change is specifically acknowledged in writing, signed by the President of Resurgence Healthcare Solutions, LLC. I acknowledge that no other promise, agreements or representations have been made contrary to this "at-will" employment agreement, and that this agreement, as acknowledged by my signature below, is the full and complete agreement governing Resurgence Healthcare Solutions, LLC., and my rights and obligations concerning termination of my employment.

Confirmation