On-Line Employment Application

To submit your application please complete the form below. Fields marked with a asterisk * are required. When you have finished click Submit at the bottom of this form.

Personal Information

First Name*

Last Name*

Street Address*

City*

State*

Zip*

Primary Phone* (with area code)

Alternate Phone

Email*

How Did You Hear About Us?

If by Board Member, Staff, Employee, Referral or Other please specify

If by board member or staff please specify

Additional Information

Have you ever worked for The Huntington at Nashua before?*

If Yes, please explain

Position applying for

Salary expectations

Desired work schedule*

Desired shift

Highest education level*

Have you ever been convicted of, or plead guilty to, a crime other than a misdemeanor traffic violation?*

If yes, which state(s), and explain

Professional Licensure / Certification

Please provide professional licenses and/or certifications below. Be sure to include Title. Expiration Date & State where licensed. Do not include any sensitive data such as your license or social security number

Professional / Business References

Please provide three (3) professional/work/school references who are not relatives or personal acquaintances.

Name and Relationship Title Company Name and Address Telephone
Previous Employment

Provide information regarding previous employment beginning with most recent employer. Alternatively, you may also attach your resume below.

Employer 1

Job Title:
Employer Name:
 Phone:
Address:
Duties:
From: (MO/YR)
 To: (MO/YR)
 Supervisors Name:
 Salary:
Reason for leaving:

Employer 2

Job Title:
Employer Name:
 Phone:
Address:
Duties:
From: (MO/YR)
 To: (MO/YR)
 Supervisors Name:
 Salary:
Reason for leaving:
Resume Attachment*

Please attach your resume. Resume must be in PDF, DOC or DOCX format. File size cannot exceed 4mb.

Cover Letter

If your cover letter is not attached to your resume please use the text area below. Include information such as goals, availability, best times to contact you, etc.

READ CAREFULLY BEFORE SIGNING
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 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 may be conditioned upon successfully passing a medical examination and that I may be required to satisfactorily complete a drug screening as a condition of employment

I hereby authorize persons, schools, my current employer (if applicable) 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.

Signature of Applicant:*
Date:*

*Required