Job DetailsHarrington Memorial Hospital is an EOE/AA/ADA employer

ApplyBack to job listings

Date(required)
Last Name(required)
First Name(required)
Middle Initial(required)
Address(required)
City(required)
State(required)
Zip(required)
Email(valid email required)
Home Phone Number(required)
Cell Phone Number
Position applying for
I am applying for
If hired, date to start
Shifts Available
Salary
Referred by
Are you a current employee of Harrington Health System?
If yes, which department?
Have you ever worked for Harrington Hospital/Harrington Physician Services?
If yes, which department?
Also, if yes, what was your reason for leaving?
Under what name were you previously employed?
Are you authorized to work in the United States?(required)
Are you at least 18 years of age?(required)
Were you in the Armed Forces?
Which branch?
Employment History
(Please list most recent first – may include any verified work performed on a voluntary basis)
Start Date
End Date
Employer
Phone Number
Job Title
Street Address
City
State
Zip
Immediate Supervisor and Title
May we contact for reference?
Summarize the nature of work performed and job responsibilities
Hours per week
Pay
Reason for leaving
Next
Start Date
End Date
Employer
Phone Number
Job Title
Street Address
City
State
Zip
Immediate Supervisor and Title
May we contact for reference?
Summarize the nature of work performed and job responsibilities
Hours per week
Pay
Reason for leaving
Next
Start Date
End Date
Employer
Telephone Number
Job Title
Street Address
City
State
Zip
Immediate Supervisor and Title
May we contact for reference?
Summarize the nature of work performed and job responsibilities
Hours per week
Pay
Reason for leaving
Professional References (mailing address required)
Name
Address(required)
City(required)
State(required)
Zip(required)
Telephone Number
Next
Name
Address(required)
City(required)
State(required)
Zip(required)
Telephone Number
Educational History
High School Name & Location
Years Completed
Course of Study
Did you Graduate?
Diploma, Degree, Certificate or GED received?
Next
College Name & Location
Years Completed
Course of Study
Did you Graduate?
Date of Graduation
Diploma, Degree, Certificate or GED received?
Next
Graduate College Name & Location
Years Completed
Course of Study
Did you Graduate?
Date of Graduation
Diploma, Degree, Certificate or GED received?
Professional Licenses
(To be completed only by applicants applying for a position which requires professional licensure.)
Are you currently professionally licensed?
Registration Number
Issue Date
Expiration Date
Profession
State
If not Massachusetts Licensed, have you applied for reciprocity?
Affidavit
I hereby certify that the answers given by me to the foregoing questions are true and correct without omissions of any kind whatsoever.

I agree that Harrington Health System shall not be liable in any respect if my employment is terminated because of the falsity of statements, answers, or omissions made by me in this application.

I authorize the hospitals, companies, schools, or persons named to give any information regarding my employment, together with any other information they may have regarding me whether or not it is in their records.

I hereby release said hospitals, companies, schools, or persons from all liability for any damage for issuing this information. I also under stand an offer of employment will be conditional on results of a pre-placement screening and drug test as well as CORI results . In consid eration of my employment, I agree to conform to the rules and regulations of the Harrington Health System, and I understand that, if hired, my employment is STRICTLY AT-WILL and I can be terminated, with or without cause, and with or without notice, at any time at the option of either the Organization or myself. I understand that no one other than the Chief Executive Officer of Harrington Health System or his/her designee, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing .

I acknowledge that I have read and understand the above statements.

Harrington Health System is a smoke-free workplace.
Signature
Date
Reference Release
I hereby authorize the release to the Human Resources departments of Harrington Hospital and Harrington Physicians Services [Harrington Health System) of any and all reference information with respect to my academic, employment and/or volunteer records including final evaluations and recommendations for future employment.
Signature
Date
Print Name
Social Security Number
Are your employment or educational records under any other name?
If yes, previous name
Attachments
Send resume? (PDF or DOC)
Send cover letter? (PDF or DOC)
Reference
How did you learn of the position?(required)
If Other

cforms contact form by delicious:days