I, hereby authorize Comet Medical Staffing Co. and its staff to begin, commencing today, to identify and refer me to one or more of its clients for a permanent, contract and/or per diem position with that client. This document by no means constitutes an employee/employer relationship.
I understand that this Agreement provides no guarantee that Comet Medical Staffing Co. will succeed in its attempts to find me a new employment opportunity and that this Agreement, therefore, does not guarantee me future work assignments, additional placement, or introduction with any clients of Comet Medical Staffing Co.
I consent to the collection of my Personal Information*, as requested by Comet Medical Staffing Co., and I understand that the information Comet Medical Staffing Co. collects will be used strictly to assist me in finding a suitable employment opportunity.
I consent to the disclosure of such Personal Information:
To Comet Medical Staffing Co. clients when, in Comet Medical Staffing Co.'s exclusive discretion, the client may provide me with a suitable employment opportunity; and, to the extent necessary to Comet Medical Staffing Co.'s representatives (including, but not limited to, affiliates, partners, and contractors) who assist Comet Medical Staffing Co. in providing staffing services.
I further consent to the retention of my Personal Information by Comet Medical Staffing Co. as long as I am utilizing Comet Medical Staffing Co.'s placement services.
In the event that I wish to withdraw my consent to the use, disclosure, and retention of my Personal Information, I understand that it is my responsibility to inform Comet Medical Staffing Co. in writing, at which time I will be notified by Comet Medical Staffing Co. how such withdrawal may affect the services being provided to me.
I fully understand the above consent statements and accept the same voluntarily, as certified by my signature below.