I hereby certify that all information given are true and correct to the best of my knowledge.

I hereby authorize St. Luke's Medical Center (SLMC) to conduct investigation and inquiries as to my personal, employment, and such other background information as may be pertinent to my qualification. I hereby release school/ employers' personnel from any liability that may arise from responding to inquiries related to this application.

In understand that any misinterpretation or omission of facts on this application shall be sufficient cause for immediate dismissal.

I agree to undergo testing for any regulated/ prohibited drug to be conducted by SLMC prior to employment and at anytime during my employment with or without prior notice. If I found positive according to the drug result, SLMC may consider this as basis of disciplinary action pursuant to the Anti Drug policy of the hospital, which may lead to termination of my employment.

I further agree to abide by all policies of the Medical Center.