I certify that my answers are true and complete to the best of my knowledge.
Any misrepresentation or omission of facts in my application, attachments to my application or interview may result in
refusal of employment or if employed, termination from employment.
In exchange for the consideration of my job application by Pueblo Medical Imaging (hereinafter called “the
Company”), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either
in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel
manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company
practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an
employee of Pueblo Medical Imaging, or otherwise to change in any respect the employment-at-will relationship
between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the
President or Practice Administrator of the Company. Both the undersigned and Pueblo Medical Imaging may end
the employment relationship at any time, without specified notice or reason. If employed, I understand that the
Company may unilaterally change or revise their benefits, policies and procedures and such changes may include
reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the misrepresentation or
omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the
Company permission to contact schools, previous employers (unless otherwise indicated), references, and others,
and hereby release the Company from any liability as a result of such contract.
I also understand the (1) the Company has a drug and alcohol policy that provides for pre-employment testing as
well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment;
and (3) continued employment is based on the successful passing of testing under such policy.
I understand that, in connection with the routine processing of your employment application, the Company may
request a Background Check including Criminal Felony & Misdemeanor, National Sex Offender Registry, Social
Security Number Validation, Social Security Trace, Health Care Sanctions, Credit report, Employment report,
Education report and Global Sanctions & Enforcement.
I further understand that my employment with the Company shall be introductory for a period of ninety (90) days,
and that at any time during the introductory period or thereafter, my employment relation with the Company is
terminable at will for any reason by either party.
This Company is an equal employment opportunity employer. We adhere to a policy of making employment
decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or
disability. We assure you that your opportunity for employment with this Company depends solely on your
Thank you for completing this application form and for your interest in our business.
E-Verify is an Internet-based system that compares information from an employee's Form I-9, Employment Eligibility Verification, to data from U.S. Department of Homeland Security and Social Security Administration records to confirm employment eligibility.