By signing and/or submitting this form, you are agreeing to the following statements:
1. "I certify that all answers given by me are true, accurate and complete. I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying documents) will be cause for denial of employment or immediate termination of employment and/or affiliation with this group, regardless of when or how it was discovered."
2. "I certify that the answers given herein are true and complete to the best of my knowledge. I also authorize investigation of all statements contained in this application as may be necessary in arriving at an employment, contracting, and/or group affiliation decision. In the event of employment, contracted relationship, or if group affiliation is granted, I understand that false or misleading information given in my application or interview(s) may result in discharge."