Employment Application For Transitional Care Unit At Hubbard Hospital - Merrimack Health Group, Inc., (MHG)

Merrimack Health Group, Inc., (MHG) - Marblehead, Massachusetts ( MA )

Employment Application For Merrimack Health Group

TRANSITIONAL CARE UNIT AT HUBBARD REGIONAL HOSPITAL
APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer. Federal and state laws prohibit discrimination in employment practices based on race, color, religion, sex, age, handicap, disability, or national origin. No question on this application is asked for the purpose of limiting or excluding any applicant's consideration for employment because of his or her race, color, religion, sex, age, handicap, disability, or national origin.

E-MAIL ADDRESS

E-Mail Address:

POSITION

Facility:
Position Desired:
If Other, indicate position you are applying:
Hours Desired:
Salary Expected:
Note: If you do not remember the Job Code for the job your are applying, please use your browser back button to retrieve it

Last Name

Middle Name

First Name

Social Security No.

Telephone No.

Address

Street

City

State

Zip Code

If your records may be under a name other
than indicated above, please specify:

For All Licensed Staff

Mass. Reg. No

Last Renewal

Date Granted

Expiration Date

Are you a citizen of the United States?

If you are not a U.S. Citizen, do you have the
legal right to remain permanently in the United States?

Explain:

Are you between the age of
18 and 70?

Do you know of any fact that would limit or impair your
ability to perform the functions of the job you are applying for?

Explain:

Where now employed?

Reason for desiring change:

EDUCATION

Name and Location of School or College		Major Subject
Graduated?	Degree	Attended From	Attended To



Name and Location of School or College		Major Subject
Graduated?	Degree	Attended From	Attended To



Name and Location of School or College		Major Subject
Graduated?	Degree	Attended From	Attended To

FORMER EMPLOYERS AND EXPERIENCE (References)

Name and Address		Nature or Experience
From	To	Salary	Reason for Leaving



Name and Address		Nature or Experience
From	To	Salary	Reason for Leaving



Name and Address		Nature or Experience
From	To	Salary	Reason for Leaving



Have you ever worked as a CNA in another State:

PERSONAL REFERENCES (Not Relatives)

Name:
Address:
Phone:
Title:
Business:



Name:
Address:
Phone:
Title:
Business:

COVER LETTER
You may "cut and paste" your cover letter in the box below.

RESUME
You may "cut and paste" your resume in the box below.

ANY ADDITIONAL INFORMATION?.

SUBMIT YOUR APPICATION:

I authorize the schools, employers, and individuals listed in this application to release any information regarding my previous employment, character, general reputation and personal characteristics:

I certify that the statements I have made in this application are true and hereby grant the employer permission to verify that accuracy and completeness of this information and to investigate all references and educational records. I understand that any false or misleading statements made by me on this application or in conjunction with my physical examination will be sufficient cause for the rejection of this application or for immediate dismissal if such false or misleading information is discovered after my employment. If I am accepted for employment, I agree to abide by the rules and regulations of the employer:

Date:

How did you hear about us?
If Newspaper, what publication?
Other:

Please note that all application information will be kept confidential and will not be sold or released.
Please see our Privacy Policy for more information.

In addition, you will receive a copy of your application form via the e-mail address entered above.

Merrimack Health Group is an equal opportunity employer.

-- PLEASE CLICK THE SUBMIT BUTTON ONLY ONCE --

Click HERE to return to the Merrimack Health Group Employment Opportunities Main Page.

Click HERE to return to the Merrimack Health Group Main Page.

Merrimack Health Group's facilities provide quality clinical care services
including the following:

Orthopaedic
Cardiac Pulmonary / Respiratory
Wound Care
Stroke
Rehabilitation including:
- Physical, Occupational, Speech

I.V. Therapies
Alzheimer's and Related Disorders
Respite Care
Hospice Care
Gero-psychiatric Programs
Post-Surgical Conditions

Please click here for a link to our facilities.

Merrimack Health Group, Inc., 25 Lafayette Street, Marblehead, MA 01945
Telephone: (781) 631-5057 Fax: (781) -631-3482