I hereby authorize Platinum Medical Staffing, to request each former employer, person, firm or corporation given as a reference to answer all questions that may be asked and give all information that may be sought in connection with this application specifically concerning my work, skill or my professional performance and reliability in the form or a reference. My employment with Platinum Medical Staffing will not begin until such references are received.


I agree, in consideration of your employing me that I will not seek or accept employment from any client of Platinum Medical Staffing without first obtaining permission from Platinum Medical Staffing. I understand that if I am in violation of this agreement, I am subject to legal action and monetary damages up to 30% of my annual salary provided by the client if I was employed by that facility as a permanent full -time employee. In addition, I agree not to switch over to the payroll of a competing agency when I am placed at a facility through Platinum Medical Staffing without the approval of Platinum Medical Staffing.


I understand that this employment application is not a contract and that if hired, my employment with Platinum Medical Staffing can be terminated with or without cause, and with or without notice, at any time, at the option of Platinum Medical Staffing I also understand that any and all benefits received pursuant to employment with Platinum Medical Staffing may be changed or eliminated at will without prior notice.


I consent to having a criminal background check done on my history, including a social security number verification, and I understand that my employment might hinge on this check, including termination if after I am hired, Platinum Medical Staffing information is acquired that precludes my employment with Platinum Medical Staffing.


I understand that all applicants may be required to pass screening for the presence of illegal drugs or alcohol as a condition of employment at Platinum Medical Staffing. I may be required to voluntarily submit to a urinalysis test at a laboratory chosen by the company and by signing this consent agreement I release Platinum Medical Staffing from liability. I understand that with positive test results I will be denied employment at this time, but I may initiate another inquiry with Platinum Medical Staffing, after 6 months provided that a drug retest is performed and negative results are received. Platinum Medical Staffing, will not discriminate against applicants for employment because of past abuse of alcohol/drugs as long as a current drug test is positive However, Platinum Medical Staffing will not tolerate the current abuse of alcohol/drugs I may also be asked to voluntarily submit to urinalysis tests for post incident screening and random drug testing at any time in the future due to a past Positive Drug test. Criminal background screening and/or Drug testing are conducted when clients who are interested in hiring me require these tests or if it is a requirement of the Department of Health/ Public Health in the states the agency operates in. Additionally, some states require that Medical Staffing Companies be licensed as a medical staffing agency. The licenses in some of these states may require that all employees have criminal background checks and or drug testing.


The representative of Platinum Medical Staffing will inform me of the regulations about criminal background checking and drug testing.


I authorize Platinum Medical Staffing to copy and forward my personnel file contents to any and all client facilities which require this of Platinum Medical Staffing. I hereby certify that all of the above information is true and correct. I understand that any misrepresentation or false information given on this application will result in rejection or termination of employment.


I authorize the obtaining of references.