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Please Read the Following Statement Carefully Before Signing

I certify that the facts set forth in my application for employment with Nurse Anesthesia of Maine are true and complete. I understand that, if employed by Nurse Anesthesia of Maine, any erroneous, false or misleading statements about or omissions of requested information on this application or otherwise provided during the employment application process shall result in my termination of employment. I agree that Nurse Anesthesia of Maine shall not be liable in any respect if my employment is terminated as a result of the falsity of statements, answers, or omissions made by me in this application.

I authorize Nurse Anesthesia of Maine and appropriate providers to verify all statements contained in this application, to make any and all necessary reference checks, and to contact any or all of my prior and current employers.

I authorize the references and employers listed previously to give Nurse Anesthesia of Maine and appropriate providers any and all information concerning my previous and current employment and any pertinent information they may have, personally or otherwise; and I release all persons, employers, and Nurse Anesthesia of Maine and appropriate providers from liability for any damage or injury that may result from furnishing such information to Nurse Anesthesia of Maine.

If employed, I agree to conform to all policies, rules, and procedures of Nurse Anesthesia of Maine. I recognize that employment at Nurse Anesthesia of Maine is at-will, and if employed, such employment can be terminated by Nurse Anesthesia of Maine or me at any time for any or no reason. No person or group of persons other than the President/Chief Executive Officer has the authority to contractually bind Nurse Anesthesia of Maine regarding terms and conditions of employment or to modify the at-will status of all employment at Nurse Anesthesia of Maine.

I understand that this application and all attachments are the property of Nurse Anesthesia of Maine

NOTE: This application will be given every consideration, but its receipt does not imply that the applicant will be employed. This application will remain active for a period of twelve (12) months. If, after such time, you still wish to be considered for employment, then you must re-apply.

THANK YOU FOR YOUR INTEREST IN NURSE ANESTHESIA OF MAINE!