I have completed the application and answered all of Global Medical Staffing’s (GMS) questions to the best of my ability. I swear that the information that I have provided is true and correct. I understand that any misrepresentation made by me may result in the immediate termination of any contractual relationship I form with GMS as well as the retroactive termination of any malpractice insurance obtained on my behalf.
I authorize GMS to speak to my references, research my background, character and qualifications to practice medicine, including malpractice history, with any college, university, medical school, residency or fellowship program, hospitals or other medical practices or institutions, state or national licensing boards, American Board of Medical Specialties, American Medical Association, American Osteopathic Association, National Practitioner Data Bank, the Federation of States Medical Boards, DEA, malpractice carriers and associated attorneys, all US or foreign federal, state or local government agencies and instrumentalities and any other pertinent source. I authorize GMS to share any information obtained with GMS clients and any medical licensing boards. I agree to hold GMS harmless from any liability whatsoever related to these processes. I further agree to hold the entities or persons listed above harmless from any liability whatsoever for the provision of information to GMS and/or for GMS’s subsequent use of such information.
I recognize that Global Medical Staffing’s (GMS) business depends on preserving its network of clients and doctors. To this end, GMS has expended considerable amounts of time, money, and energy. Recognizing GMS’s investment, I agree not to introduce other doctors to the locations GMS provides to me. I also agree not go around GMS by accepting any type of employment position at a location where GMS presents my CV for consideration for a position, or provides me with information (verbally, in writing or by any other means). Should I go around GMS, in contradiction to this agreement, and establish any type of employment relationship, for myself or for any other doctor, I agree that GMS is entitled to its customary placement fee.