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I understand and certify that all information supplied in this application is complete and correct. Any false, misleading or incomplete information furnished by me regarding this application may result in the rejection of this application or if employed, dismissal. I understand that in consideration of my employment, I agree to conform to the rules and regulations of the company, and further agree that my employment and compensation are at the will of the company and can be terminated, with or without cause, and with or without notice at any time at the option of either the company or myself.

I understand and herby authorize all persons, schools, companies, employers and/or their representatives to furnish verification to the company, its representatives or agents, any and all information set forth in this application. In addition, I hereby agree to hold harmless and to release from all liability all said persons, schools, companies, employers and/or their representatives from any and all claims that I may have, or which may arise, against any and/or all of them, including the company as a result of them furnishing information to the company. I authorize the company, should they employ me, to release employment references, if my employment becomes terminated for any reason. I also authorize the company to conduct credit, police, criminal and driving record inquires, or any other employment related inquiries in compliance with the provisions of the Fair Credit Reporting Act, 15 U.S.C. Section 1681, et. seg. I understand that the decision to hire me and my continued employment will be subject to the results of these inquiries.

Northwest Michigan Surgery Center, LLC is an equal opportunity employer. No question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or federal law.

The company has a firm commitment to its employees, customers and the public to provide the safest and most competent services possible. The nature of our businesses requires that we promote high standards of employee health. Therefore, any employee sustaining an on-the-job injury that requires medical treatment or that involves damage to company property may be requested to submit to a blood and/or urine test to determine the possible presence of drugs and/or alcohol. Any employee guilty of serious safety infractions, including near-miss situations, or failure to follow established safety procedures may be subject to testing under this policy.

TERMS OF ACCEPTANCE and SIGNATURE
I, the applicant, warrant the truthfulness of the information provided in this application
Name:
"Everyone was friendly from check in to discharge. I am very impressed and pleased. You have a fabulous staff. It couldn't possibly have been a better experience. "
- Claudia S.
"If procedures are necessary, it is a pleasure having them done at the Surgery Center. All processes have been well thought out and streamlined with the patient in mind. There does not seem to be any unnecessary steps or duplication of effort."
- Gary P.
"Excellent care --- and my anesthesiologist was very caring about my comfort throughout the surgery."
- Ellen L.
"Always such a nice experience here when you're having medical procedures done. It's never fun, but I try to be positive about it and the staff and docs are great. Glad to find good care here 'Up North.' "
- Heidi P.
"The follow up phone calls both from the surgeon and nurse were very comforting, and appreciated. All in all, a first class operation; thanks for your caring"
- Lee M.