“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, false statements on this application shall be grounds for dismissal. I authorize Mount St. Joseph Rehab Center to investigate all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I agree to a pre-employment medical exam, including chest x-ray and or mantoux skin test as condition of employment. If employed by Mount St. Joseph Rehab Center, I agree to comply with all rules, regulations and personnel policies at Mount St. Joseph Rehab Center. I also agree to take an annual chest x-ray or mantoux skin test.” This original application for employment will become a part of my personnel record as well as any other information obtained through pre-employment screening.