I hereby certify that all entries on this application are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part to any employment in the service of TeleMed, Inc. I understand that all information on this application is subject to verification. I consent to references and former employers and educational institutions listed being contacted regarding this application. I further authorize TeleMed to rely upon and use, as it sees fit, any information received from such contacts.