Note: Answering 'yes' does not automatically exclude you from further consideration of employment. A conviction will not necessarily disqualify you

Describe any educational degrees, skills, training, or experience you believe are relevant to the job applied for.

Begin with your most recent employer. Include any internships, volunteer activities, military service assignments and account for all periods of unemployment.

Please list 3 persons – previous supervisors, co-workers, etc. - who are not relate to you.

This section is for medical staff applicants (Registered Nurses, Nurse Practitioners, and Physician Assistants) only.

I hereby certify that I have read and fully understand this application. Prior to signing below, I had the opportunity to ask LaserAway about this application and to clarify any questions I might have had concerning this application form.

I hereby certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document may disqualify me from further consideration for employment. I further understand that , if employed, any misrepresentation or omissions of facts in any application document may be cause for my dismissal at any time without prior notice. I consent to and authorize LaserAway to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and professional references to give LaserAway (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party for providing a good fafaith reference.

I expressly agree and understand that, if employed, my employment is not for a specific term, is based on mutual consent and may be terminated by me or LaserAway with or without notice or cause at any time. I further understand that no oral promise, company policy, custom, business practice or other procedure (including the basic employment policies, employee handbook, or any personnel manuals) constitute an employment contract or modification of the at-will employment relationship between me and LaserAway. I also understand that this aspect of my employment may not change absent an individual written agreement signed by both me and the president of LaserAway.

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation; take a pre-employment drug test. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required test. I authorize LaserAway to release the results of background checks (if any) and my pre-employment drug/alcohol test (if any), any information on this application and any relevant information about me to each other and release LaserAway from any and all claims related to the lawful release of this information. I further authorize the release of any background check results of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document.

I acknowledge that this application will remain active for 30 days from this date. If I have not heard from LaserAway at the conclusion of this 30 day period, it is my responsibility to complete a new application if I still will to be considered for employment.

California Applicants Only:

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.