I certify that the facts stated on this application are true and complete to
                                            the best of my knowledge, and I grant Ambu-Star permission to verify all
                                            such information. I understand that any false statement, misrepresentation
                                            or omission of facts on this application may result in rejection of the
                                            application for further employment consideration or my immediate dismissal
                                            if discovered subsequent to my employment. I further agree that Ambu-Star
                                            shall not be liable in any respect if my employment is terminated because of
                                            any false statement, misrepresentation or omission of facts made by me in
                                            connection with this application.
                                        I understand that the information will be checked and the previous employers
                                            will be contacted for the verifying the information contained therein. I her
                                            by grant Ambu-Star permission to check my references and to verify the
                                            information contained in my application. Further, I authorize my former
                                            employers, personal references and others to give any information concerning
                                            my request by Ambu-Star. I agree to have per-placement medical examination,
                                            per-placement drug screening, and any further medical examination that may
                                            be required my Ambu-Star. 
                                        I understand that the information will be checked and the previous employers
                                            will be contacted for the verifying the information contained therein. I her
                                            by grant Ambu-Star permission to check my references and to verify the
                                            information contained in my application. Further, I authorize my former
                                            employers, personal references and others to give any information concerning
                                            my request by Ambu-Star. I agree to have per-placement medical examination,
                                            per-placement drug screening, and any further medical examination that may
                                            be required my Ambu-Star. 
                                        I understand that this application is not intended to be a contract of
                                            employment and I understand that this application for employment is no way
                                            obligates Ambu-Star to employ me. However, should I be employed, I agree to
                                            comply with all orders, rules and regulations established by Ambu-Star and I
                                            understand that my duties and schedule may be altered or my job terminated
                                            based on Ambu-Star needs. 
                                        By Submitting this application indicates that I have read, understood
                                                and agree to the terms and conditions as listed above. 
                                     
                                    
                                        
                                            I give license and approve AmbuStar and to begin a “Pre-Employment”
                                            background check with the information I have provided in this application.