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(Please note that verification is required by law if you are offered a position.)
IN ACCORDANCE WITH MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE ANY APPLICATNT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OR A MISDEMEANOR AND SUBJECTTO A FINE NOT TO EXCEED $100.
Medical Examination Consent: If I receive an offer of employment from Calvert Internal Medicine Group, I consent to submit to any legally permissible medical or physical examinations, including but not limited to blood, urine, breath or other examinations or tests for alcohols, drugs, perception-altering or controlled substance use, that may be requested by Calvert Internal Medicine Group. I understand that any offer of employment will be contingent upon the results of pre-employment medical or physical examinations, in the sole discretion of Calvert Internal Medicine Group. I further agree to take any such legally permissible examinations that may be requested by Calvert Internal Medicine Group during my employment, should I be offered and accept a job, with the understanding that these examinations will be performed by a health care professional designated by Calvert Internal Medicine Group. I further hereby authorize the release to Calvert Internal Medicine Group of all results of any such tests or medical or physical examinations performed on me at that time by any physician or clinical to which I am referred by Calvert Internal Medicine Group. I further authorize the use of this information by Calvert Internal Medicine Group for any legitimate purpose, including but not limited to my employment, subsequent performance evaluations, promotion decisions, discipline, or termination.
Background Check Release: I hereby give Calvert Internal Medicine Group (CIMG) the right to conduct a thorough background investigation and obtain a consumer report or investigative consumer report, as permitted by state and/or federal law, including, but not limited to: education, references, credit history, criminal background, and driving records; and I release from all liability all persons, companies and corporations supplying such information. I release, indemnify, and hold harmless Calvert Internal Medicine Group and its subsidiaries from and against any and all liability that may result from making such an investigation. I understand that any offer of employment may be contingent upon the results of the background check, in the sole discretion of Calvert Internal Medicine Group.
Representations by Applicant: I hereby certify that the information I have provided in connection with my application for employment is true and complete. I understand that any false or misleading information or misrepresentations by omission in my application form or any related document, interviews or other aspect of my application can result in my disqualification as a candidate for employment or my immediate discharge if already employed. I also understand that nothing contained in this employment application or granting of an interview is intended to create an employment contract between Calvert Internal Medicine Group and myself for either employment or for granting of benefits. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Calvert Internal Medicine Group unless made in writing. If an employment relationship is established, I understand and agree that it is at-will, meaning either I or Calvert Internal Medicine Group may terminate my employment at any time with or without cause or notice.
I understand and agree that Calvert Internal Medicine Group and its subsidiaries (hereinafter, collectively “Company”) may request a consumer report for the purpose of obtaining information pertinent to my prospective or actual employment with the company or any of its subsidiaries. I understand that the report may contain information bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, as permitted by and in compliance with applicable state and federal law. I understand that this information my be obtained in whole or in part through personal interviews with my neighbors, friends, associates, acquaintances, or others who may have knowledge concerning such information, in which case the consumer report is considered an “investigative consumer report.” If an investigative consumer report is requested by Calvert Internal Medicine Group, I have the right to request in writing, within a reasonable time after receiving notice of the request, a complete and accurate disclosure of the nature and scope of the investigation requested. Offers of employment and continued employment are conditional upon Calvert Internal Medicine Group’s receipt of a consumer report that is acceptable to Calvert Internal Medicine Group at Calvert Internal Medicine Group’s sole discretion. Any applicant who refuses to sign this Fair Credit Reporting Act Authorization and Disclosure form will not be eligible for employment. I also understand that nothing contained in this employment application or granting of an interview is intended to create an employment contract between Calvert Internal Medicine Group and myself for either employment or for granting of benefits. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Calvert Internal Medicine Group unless made in writing. If an employment relationship is established, I understand and agree that it is at-will, meaning either I or Calvert Internal Medicine Group may terminate my employment at any time with or without cause or notice.
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