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I hereby authorize Grand Island Surgery Center and/or any of its agents to make an independent investigation of my background for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. This investigation may access records maintained by both public and private organizations. Information requested may include, but is not limited to:

Professional and personal references, credit history (credit bureau report), public records, past and current employment, motor vehicle records, education, criminal and police records, professional credentials, and urine or blood test to determine drug or alcohol use.
I authorize any individuals or entities contacted during this investigation to give you any and all information required that they might have, personal or otherwise, and release all parties from any and all liabilities, claims or lawsuits in regard to the information obtained.

I understand that the complete and final results of Grand Island Surgery Center's investigation into my background may affect my initial or continuing employability. I also understand that this is a requirement for employment.

Personal Information