I acknowledge that in connection with my application for employment, promotion or reassignment with Charlotte Eye Ear Nose & Throat Associates, P.A., an investigative consumer report or other inquiry may be made as to my character, general reputation, personal characteristics and mode of living. If a report is made, I have been advised further that upon written request, within a reasonable time, additional information as to the nature and scope of the report, if one is made, will be provided. This written request should be made to the Human Resources Department where this application is made.

I hereby authorize all personnel, schools, companies, corporations, credit bureaus and law enforcement agencies to supply any and all information pertinent to my employment and release the same from any liability resulting from providing such information. Charlotte Eye Ear Nose & Throat Associates, P.A., has my permission to make said inquiries and I hereby release Charlotte Eye Ear Nose & Throat Associates, P.A., from any liability in making said request or in relying on the information received.

I understand that satisfactory reports are a condition of my employment with Charlotte Eye Ear Nose & Throat Associates, P.A. I further understand that my employment with Charlotte Eye Ear Nose & Throat Associates, P.A., will be terminated if management determines that said reports are unsatisfactory.

I also acknowledge that from time to time Charlotte Eye Ear Nose & Throat Associates, P.A., may be required to submit certain information with regard to my employment or application for employment. I hereby release the Company, its agents, assigns and subsidiaries from any liability resulting from submitting such information.

I understand that if I am employed, employment is not for a stated period. Either Charlotte Eye Ear Nose & Throat Associates, P.A., or I may discontinue the employment relationship at any time without cause or notice. Only the CEO of Charlotte Eye Ear Nose & Throat Associates P.A., has the authority to enter into an agreement contrary to the foregoing, and then such agreement must be in writing and signed by the CEO and the employee. No other employment practices, written or oral policy or statement by anyone, including department managers or any other management personnel, can alter this employment relationship.

I acknowledge that Charlotte Eye Ear Nose & Throat Associates, P.A., may request either prior to, during, and/or after employment that I undergo drug testing and may request, after an offer has been made, a medical exam. I consent and agree to any exam, if required, now or in the future. I understand that when pre-employment drug testing is required a satisfactory result is a condition of employment with Charlotte Eye Ear Nose & Throat Associates, P.A.

I hereby certify that all statements and answers made on the Employment Application are complete and true. I understand that if subsequent to employment any such statements and/or answers are found to be false or that information is omitted, such false statements or omissions will be considered ground for termination of my employment.

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