Speed-E'z Employment - Information Release



Speed-E'z Physician Exchange Employment Application Please complete the form fully ON LINE, print, sign and date where required, and mail or fax the completed forms to the address below. Thank You
Name
Authorization for Release of Information Acknowledgement
	Information given by me in my application and during the application process is true and correct to the best of my knowledge. I understand that if I am employed by Speed-E'Z Exchange INC, any omissions of fact and/or false or misleading information may lead to my immediate dismissal. I authorize the company to verify such information and to contact any reference given by me. I authorize all persons, investigative agencies, business organization, schools, companies, corporations, credit bureaus, and law enforcement agencies to supply the company with any information about me that the company might request. If I am employed, my employment shall be in accordance with the terms of my employment application and existing company rules and regulations. The company shall have the right to amend, modify, or revoke its rules and regulations at any time. I will familiarize myself promptly with such rules and regulations now or hereafter in effect. Employment may be terminated by the company at any time with or without reason or cause, its only obligation being to pay wages earned by me to date of termination. I may terminate my employment at any time, subject to applicable notice requirements. Signature: Date:
Please check your forms for accuracy and fax all completed forms to: Fax: 210-576-5496 or mail to: Speed-E'z Exchange, Inc. The Park on Medical 4115 Medical Drive, Suite 205 San Antonio, TX 78229