Employment Application

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired.

I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, educational and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulation of the company, which rules may be changed, withdrawn, added or interpreted any time, at the company's sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.

I hereby authorize IQS, Inc. to investigate all facts contained in my application for employment with said company, and authorize the release of any and all information by my present and past employers, wherever located, which may require for a reference check. I further authorize all of my previous employers and current to give any and all information concerning my employment and other patient information which said employers may have, personal or otherwise, and I release all parties from liabilities for any damages which may result from the furnishing of said information.