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Personal Information

Any Previous Names *

Mailing Address

Contact Details

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Step 2 of 10

Job Information

Do You Have any Relatives or Friends Employed at this Facility? *

Have You Ever Been Employed by this Facility? *

Are You 18 years of Age or Older? *

Are You Legally Authorized to Work in the US? *

Shift Preference *

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Would You Consider Working?

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Are you Applying for *

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Step 3 of 10

Education/Skills

Have You Attended High School? *

Have you attended College? *

Other

Including Business College, Special Courses, Military Training, Post-Graduate, Nursing

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Step 4 of 10

Licenses, Certifications, and Registration

Please add any licenses, certifications, or registrations below.

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Languages

English

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Read *
Write *

Portugese

Speak *
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Additional Languages

Please add any additional languages below.

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Step 6 of 10

Experience

Please list prior work experience below.

Have you volunteered your time or services? *

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Step 7 of 10

References

Please list three (3) references who are not relatives or employers.

Reference 1 *

Reference 2 *

Reference 3 *

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Step 8 of 10

Self Identification Form

Partners HealthCare System, Inc. Martha’s Vineyard Hospital and Windemere Nursing and Rehabilitation Center are equal opportunity/affirmative action employers. We are required to annually report to the federal government the racial/ethnic makeup of our applicant pool. The provision of this information by the employee is voluntary.

Gender *

Race/Ethnic Group *

please check all applicable categories
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Step 9 of 10

Upload Resume

Please have your name in the title of the resume
Formats we accept: .pdf, .doc, .docx
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Step 10 of 10

Terms and Agreements

By pressing the submit button, I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I understand that employment will be conditioned upon successfully passing a medical examination and that I will be required to satisfactory complete a drug screening as a condition of employment. I hereby authorize persons, schools, my current employer (unless noted above) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of such information. I understand that my employment is at-will which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that the facility has the same right. I understand that no one has the authority to enter into any agreement contrary to the preceding sentence, except for a written agreement signed by an administrative representative of this facility and notarized. I understand that it is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Terms and Agreements *

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