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I certify that the information I provided Suburban Radiologic Consultants, Ltd. (SRC) in this application and during the hiring process is true and complete. I understand and acknowledge that any false, misleading or incomplete information in the application or during the hiring process may result in rejection of my application or, if I have been hired, immediate termination of employment. I authorize SRC to investigate the information contained in this application or otherwise provided by me and release SRC and its employees and agents from any and all liability for seeking information and opinions on me. I authorize all employers, education institutions, entities, and persons listed in this application or identified by me to provide information about me and hereby release them from all liability for issuing information. I hereby waive any privilege I have to such information.

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