Begin with your most recent employment. Include military assignments. (You may exclude those that indicate race, color, religion, sex, sexual preference or national origin)

List Professional, Trade, Business or Civic Activities and Offices Held. (You may exclude those which indicate race, color, religion, sex, sexual preference or national origin)

I certify that the answers given herein are true and complete to the best of my knowledge.

I authorize investigation into all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in corrective action up to and including termination. I understand that I am required to abide by all rules, policies and regulations of the company.

I understand that, if I am hired, my employment is at-will, that I am not employed for any definite term, that I may be terminated at any time, with or without cause or advance notice. I understand that the Organization retains the right to unilaterally modify, revise, add to, or delete from its employment policies and that I will be given reasonable notice of such changes via e-mail. I further understand that I am responsible for reading and understanding all policies including new or revised policies and procedures to the Human Resource Manual when notice has been received.

Genesys PHO and Providers Management, Inc. are Equal Opportunity Employers. In adherence to applicable state, federal and local laws, all employees and applicants will be treated in employment practices without regard to race, color, religion, age, sex, sexual preference, national origin, disability, or veteran status.