EMPLOYMENT SUBMISSION AUTHORIZATION:  (Please read carefully)

I authorize Fortis Group to verify any information I have provided and I further authorize any of the named schools, companies or persons listed to provide any information about me contained in their records.  I understand and agree that any misrepresentation, falsification or omissions by me in this application may be sufficient cause for cancellation of the application and/or separation from Fortis Group if I have since been employed.  My signature below hereby authorizes disclosure of information and releases Fortis Group, its officers, agents and employees from liability for such disclosure. I recognize Fortis Group’s right to require an employment health assessment, which can include a drug test.  I further understand that submitting to various tests is a condition of my employment, and I agree to cooperate in their administration.  I understand that my employment may be contingent upon completion of a fingerprint impression form and a criminal background check, at my expense, and I agree to cooperate in this undertaking.  I understand that should I be hired for the position for which I am applying, or any subsequent position, either Fortis Group or I may terminate the working relationship at any time and for any reason.  I understand that no contract may be made orally, regardless of the reliance of the employee to such statements made by any manager at Fortis Group.  I further understand that if employed, my wages and position may change, but my status as an employee-at-will will never change during my employment.  Completion and/or submission of this application does not constitute an offer of employment.

Fortis Group ensures a non-discriminatory environment regarding employment practices.  Fortis Group complies with all federal regulations, and is committed to a program of equal opportunity.