I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that submitting this application does not constitute an offer or guarantee of employment, U.S. professional licensure, visa sponsorship, immigration approval, or placement.

I authorize Anthem PB, LLC to review the information and documents I voluntarily submit for the purpose of evaluating my eligibility for potential healthcare recruitment and employment opportunities. I understand that additional authorization may be required before Anthem PB or an authorized third party conducts formal credential, professional-license, employment, reference, or background verification.

I understand that participating healthcare employers make their own hiring decisions and that U.S. licensing authorities, credentialing organizations, immigration authorities, and other applicable agencies determine professional and immigration eligibility.

I agree that Anthem PB may contact me regarding my application and relevant recruitment opportunities.

Applicant Name: —

Date: 2026-09-08