Employment Application

I certify that answers given in this employment application are true and complete. I authorize investigation of all statements contained in this application for employment and any related documents as may be necessary to arrive at an employment decision. I will produce the original/certified true copies of all identification and qualification documents as required by Med Atlantic, Inc., or Virginia Urology Center PC (each, a “Company”). I authorize investigation of my work history and the giving and receiving of any information requested by Company to verify all data given in my application for employment, related documents or oral interviews. I release from liability any person giving or receiving any such information. I understand that falsification of data so given or other derogatory information discovered as a result of this investigation may prevent my being hired, or if hired, may subject me to immediate dismissal. I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with the Company is of an “at will” nature, which means that I do not have a contract of employment for any duration or limiting the grounds for my termination. If employed, I may resign at any time and the Company may terminate my employment at any time with or without notice or cause. I understood that while personnel policies, programs and procedures may exist and may be changed from time to time, this “at will” employment relationship may be changed only by a written contract signed in writing by an authorized executive of the Company. In the event of employment, I understand that if I provide false or misleading information in this employment application or interview(s) or if I omit relevant information, the Company will have the right to rescind any verbal or written offer of employment and may result in the termination of my employment if I am hired. I understand, also, that I will be required to abide by all rules and regulations of the Company.

EQUAL OPPORTUNITY EMPLOYER: Med Atlantic, Inc. and Virginia Urology Center P.C. are committed to the principle of equal employment opportunity for all job applicants and employees and are proud to be equal opportunity employers. Our employment decisions are based on business needs, job requirements and individual qualifications and we consider applicants for all positions without regard for race, color, religion, creed, gender, age, national origin, disability, genetic information, marital or veteran status, or any other legally protected status.