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Complete the job application below.  Attach your resume in the field provided.

NOBLE VISITING NURSE AND HOSPICE SERVICES, INC. IS AN EQUAL
OPPORTUNITY EMPLOYER AND CONSIDERS APPLICANTS FOR ALL
POSITIONS WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX,
NATIONAL ORIGIN, AGE, DISABILITY, MARITAL OR VETERAN
STATUS, POLITICAL BELIEFS, ANCESTRY OR SEXUAL ORIENTATION.
Fields marked by an asterisk * are required.
 
Application Date: *
 
PERSONAL INFORMATION  
Last Name: *
First Name: *
Middle Name:
Street Address:
City, State, Zip: ,
Phone 1: *
Type:
Phone 2:
Type:
Your Email:
 
Are you a citizen of the United
States or do you have the lawful
right to work in the United States?		 Yes No
Are you under 18 years of age? Yes No
Do you have a drivers license? Yes No
Have you ever been convicted of
a felony? (1)

 Yes No
If yes, please explain:
(1) Applicant should be aware that an affirmative response will not necessarily
disqualify them from employment.
   
Position applied for:
Salary Desired:
Are you interested in: Full-Time Part-Time: Hrs/week
Per Diem
If hired when could you start?
Have you worked here before? Yes No
If yes, what was your position?
From (mm/yr):
To (mm/yr):
 
If you are applying for a position which requires State or Federal
Licensure or Certificate please list below.
License Number/State:
Type of License:
Expiration Date:
License Number/State:
Type of License:
Expiration Date:
 
EDUCATION
School Name:
Address:
From (mm/yr):
To (mm/yr):
Degree:
Course of study or Major:
Completed: Yes No
 
School Name:
Address:
From (mm/yr):
To (mm/yr):
Degree:
Course of study or Major:
Completed: Yes No
   
School Name:
Address:
From (mm/yr):
To (mm/yr):
Degree:
Course of study or Major:
Completed: Yes No
   
School Name
Address:
From (mm/yr):
To (mm/yr):
Degree:
Course of study or Major:
Completed: Yes No
 
EMPLOYMENT HISTORY
Please begin with your last or current employer.
Experience as a volunteer is considered as work experience.
Employer Name:
Position Held:
From (mm/yr):
To(mm/yr):
Address:
Reason for leaving:
Rate of pay:

Description of Duties:
   
Employer Name:
Position Held:
From (mm/yr):
To(mm/yr):
Address:
Reason for leaving:
Rate of pay:

Description of Duties:
   
Employer Name:
Position Held:
From (mm/yr):
To(mm/yr):
Address:
Reason for leaving:
Rate of pay:

Description of Duties:
 
OTHER SKILLS
Computer Skills: None
Basic
Advanced
   
Summarize any special skills
and qualifications acquired
from employment or experience
you feel pertain to your application:
Attach Your Resume:
 
Please Read The Following Before Submitting This Employent Application:
  • I certify that answers given herein are true and complete to the best of my
    knowledge.
    		•
  • I authorize investigation of all statements contained in this application and
    understand that any misstatement of fact shall be cause for dismissal.
    		•
  • I understand my employment is conditional until I successfully pass a reference
    check.
    		•
  • All potential employees must complete a CORI check in order to be considered
    for employment.
    		•
  • Upon being offered employment, I agree to submit to a medical examination
    to determine my physical capability of performing the essential functions of the
    offered position.
    		•
  • I also understand that my employment is contingent upon passing the medical
    examination.
    		•
  • As a condition of my employment, I understand that Noble Visiting Nurse and
    Hospice Services' policy requires all employees to share day, evening and
    weekend duty in accordance with Agency needs and that reassignment of
    employees will also be in accordance with the needs of the Agency.
    		•
  • I understand that this application is not and is not intended to be and established
    contract between Noble Visiting Nurse and Hospice Services, Inc., and myself.
    		•
  • I acknowledge that, in addition to the application, no other written or oral
    communication from employer representatives is intended to create an
    employment contract binding on any party.
    		•
  • It is unlawful in Massachusetts to require or administer a lie detector test as a
    condition of employment or continued employment. An employer who violates
    this law shall be subject to criminal penalties and civil liability.
    		•
  • I acknowledge that if employed, I will be required to show proof of citizenship
    or other evidence to show that I have an unrestricted right to work in the
    United States.
    		•
  • An applicant for employment with a sealed record on file with the commissioner
    of probation may answer no record with respect to any inquiry herein relative to
    prior arrests, criminal record, court appearances or convictions. In addition, any
    applicant for employment may answer no record with respect to any inquiry
    relative to prior arrests, court appearances and adjudication in all cases of
    delinquency or as a child in need of services which do not result in a complaint
    transferred to superior court for criminal prosecution.
    		•
  • I understand that I am required to abide by all rules and regulations of Noble
    Visiting Nurse and Hospice Services, Inc.
    		•
     
      I have read all the statements presented above (check box before
            submitting application)