Employment Application - Hand of Mercy Heath Care

First Name

Last Name

Today's Date

Email

Phone

Address

Position Applying For

Areas Applying For

Portland Area Augusta - Waterville Area Augusta Area Waterville Area Auburn - Lewiston Area Bangor Area

If you selected “Other” above, please type the position you are applying for below.

Consent

Type your name below if you agree to the above statement, if not type "decline "

Are you legally eligible to work in the US?

Yes No

Are you a veteran?

Yes No

Do you consent to a background check?

Yes No

Have you ever been convicted of a felony?

Yes No

May we contact your current employer?

Yes No

If you selected “No” above, please explain why?

Do you know anyone who works for us?

Yes No

If you selected “Yes” above, what's their name?

Have you worked or applied with us before?

Yes No

If you selected “Yes” above, when?

How did you hear about us?

Who is your current or most recent employer?

Name of your current or most recent supervisor/manager

First Name

Last Name

Current role/job title

Current or most recent employer’s email address

Current or most recent employer’s Phone

Reason for leaving your current job

Available start date if hired

Reference 1

First Name

Last Name

Email

Phone

Relationship

Reference 2

First Name

Last Name

Email

Phone

Relationship

Reference 3

First Name

Last Name

Email

Phone

Relationship

Can we contact your references?

Yes No

What is your highest level of education?

If you selected “Other” above, please type your highest level of education below.

Please select at least one of the following requirements

What is your major/s?

Second major or minor

Yes No

What is your second major/minor?

School name for highest level of education

Upload your resume and any other applicable documents

Select one or more files. Allowed files: PDF, JPG, PNG, Word, Excel, and TXT. Maximum size: 25 MB per file. Files are stored in the PortalDesk secure upload area and downloaded through permission-checked links.

Message or Comment "Optional"

Consent