Application

I hereby certify that all of the facts and information listed on this employment application and job skill inventory are true and complete. I understand that any false, incomplete or misleading information given by me on this application is sufficient cause for rejection of this application. I also understand and agree that any such false, incomplete, or misleading information discovered on this application at any time after I am employed may result in my dismissal.

I hereby authorize the Company to investigate all statements contained in this application and to interview or make inquiries of the references, educational institutions or licensing bodies, and previous employers listed in this application or identified by me. I authorize the references and previous employers listed to give the Company all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise, and release all such parties from any liability which may allegedly arise from furnishing such information to the Company, including, but not limited to, any liability for defamation or invasion of privacy.

I further consent to Soliant Health’s providing information obtained from my references, educational institutions, licensing bodies, and previous employers to potential employers on my behalf, and release Soliant Health from any liability which may arise from furnishing such information to potential employers, including, but not limited to, any liability for defamation or invasion of privacy.

If I am offered employment, I understand that such an offer may be conditioned upon satisfactory results of a background investigation and/or Company medical examination or inquiry, in some circumstances, as may be requested by or required for temporary assignments. I further understand and voluntarily agree as a condition of employment or my continued employment, that I may be requested by the Company to submit to a urinalysis or other drug screen test and that my failure to take such test(s) when requested to do so or unsatisfactory test results will disqualify me from consideration for employment, or if I am then employed, may result in my immediate dismissal.. I further understand that my employment and compensation can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my introductory period, at the option of either Soliant Health or myself.

I understand that Soliant Health has not made, does not make and cannot make any express or implied promise or guarantee regarding the type or quality of work that I may receive. In addition, as promises regarding the duration of any assignment can never be made, any past or future reference in advertisements or otherwise to “permanent”, “perm” or similar job descriptions should not in any way be construed as a promise or guarantee by Soliant Health to me regarding a job’s duration.

I understand that if I am ever offered an assignment by Soliant Health, it is my responsibility to contact my Soliant Health branch office when my assignment ends in order to receive another assignment. I also understand that if I fail to contact my Soliant Health branch at the end of any assignment for another assignment, I may be considered to have voluntarily quit my employment, without good cause, with Soliant Health. Furthermore, I understand that my failure to contact Soliant Health for another assignment at the end of any assignment may cause me to forfeit any unemployment benefits.

I understand and agree that any controversy or dispute arising out of this application or my employment or termination of employment between me and the Company shall be resolved by final and binding arbitration. Such arbitration shall be conducted pursuant to the American Arbitration Association rules of employment disputes and conducted before a single arbitrator. I waive a jury trial for any such controversy or dispute. My costs or expenses to initiate any arbitration hereunder shall not exceed the costs to initiate an action for the same claim(s) in a court of competent jurisdiction. Each party shall bear their own costs and expenses in prosecuting or defending any claim(s) except to the extent substantive law under which the claim(s) is brought provides otherwise. The decision of the arbitrator shall be final and binding and enforceable in any court of competent jurisdiction.

I understand and agree that prior to any assignment I will have access to the company’s policies and procedures as provided in the Healthcare Professional’s Resource Guide and that acceptance of assignments shall constitute my agreement to comply with the policies, practices and procedures contained therein and that my failure to adhere to such policies, practices and procedures may result in termination of assignment and employment with Company.

I certify that I have read, understand and agree to the above.