I certify that the information contained within this application is correct to the best of my knowledge and I understand that falsifications, misrepresentations, or omissions are grounds for dismissal or rejection of this application.
I authorize Frederick Health to conduct reference and police record inquiries as it deems appropriate. Continued association with Frederick Health may be contingent on the results of this investigation.
I authorize all references listed in this application to give the Hospital any and all information that they may have, and release all parties, including the Hospital, from all liability for any damage that may result from furnishing same to Hospital.
In consideration of my volunteer service, I agree to conform to the rules and regulations of Frederick Health and the Volunteer Program.