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Attestation

I certify that the information contained in this Employment Application is correct to the best of my knowledge. I authorize investigation of all matters contained in the application and agree that any misleading or false statements would render this application void and would be sufficient cause for immediate dismissal in the event of employment. I understand that my employment is contingent upon satisfactory completion of both a physical examination and background check investigation plus the receipt of satisfactory work and education references. I authorize and request the release of information regarding my employment record (including a statement of whether I am eligible for rehire, reason for separation, work performance, abilities and qualities relevant to my application for employment), and release Long Island Community Hospital and its affiliated and related entitles, and all my present and former employers, their agents and representatives from any and all liability arising from the release or communication of this information. I authorize and request the release of information regarding my academic record to Long Island Community Hospital and any of its affiliated and related entities. I represent that there are no restrictive covenants, non-compete agreements, non-disclosure agreements or other contractual limitations that prevent me from accepting employment and performing the full functions of my position at Long Island Community Hospital. I agree, if employed to provide acceptable proof of age and work authorization and to abide by all rules and regulations of Long Island Community Hospital. If employed, I authorize Long Island Community Hospital and any of its affiliated and related entities to conduct any and all verifications as permitted by federal, state, and municipal codes and regulations. I understand that my employment is not governed by any written or oral contract and is considered an "at will" arrangement. This means that I am free, as is Long Island Community Hospital and its affiliated and related entities, to terminate the employment relationship at any time as long as there is no violation of applicable federal, state or local law.