I certify that the information provided herein is correct and complete. I authorize HealthCare Talent, Inc. or its designated representative, to investigate and verify any of the information bearing on my employability and to use this information in connection therewith. I authorize and request any and all persons including, without limitation, employers, former employers, references, schools, credit agencies, law enforcement agencies, other government agencies and any other person who may have information relative to my abilities, business activities, police record, educational history, etc., to disclose all information to HealthCare Talent or its representatives, and I release HealthCare Talent, representatives, employers, former employers, references, school, agency and persons and their successors or assigns from any and all liability of whatever nature arising from the investigation into my background by reason of furnishing such information to HealthCare Talent or its representative.
I understand that any misrepresentation (by omission or concealment or by false, misleading or partial answers) may result in the withdrawal of work opportunities or the cancellation of any explicit or implied obligations.
I understand that the offer of work opportunities with HealthCare Talent is contingent upon satisfactory completion of any investigation which may undertake or direct concerning myself or any information furnished in connection with my candidacy for employment.