Health Care Employment in Pittsfield Massachusetts

Berkshire Place, 89 South, and At Home with Berkshire Place do not discriminate in hiring or employment on the basis of race, color, religion, sex (including pregnancy), sexual orientation, marital status, familial status, gender identity and expression, national origin, results of genetic testing, marital status or ancestry; or on the basis of age against those whose age is over 40; or on the basis of a disability not limiting the applicant's ability to perform the applied for job satisfactorily; or military status or status as a veteran, Vietnam Era Veteran, or being a member of the Reserves or National Guard. No question on this application is intended to secure information to be used for such discrimination. (In addition, 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.) We will give this application every consideration, however, in accepting it, Berkshire Place, 89 South, or At Home with Berkshire Place make no commitment of employment to the applicant.

I give my permission to share this application among Berkshire Retirement Home, Inc., 89 South Care Support, Inc., and At Home with Berkshire Place, LLC, which are separate, but affiliated organizations by placing my initials in the box below.(Required)

Basic Information About Yourself

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone(Required)

Secondary Phone

Email(Required)

Enter Email Confirm Email

How did you learn about this opening?(Required)

If you learned about the opening from an individual, who was it?

Have you ever applied for a position at Berkshire Place, 89 South or At Home with Berkshire Place before?(Required)

Yes

No

Do you know anyone currently employed at Berkshire Place, 89 South or At Home with Berkshire Place?(Required)

Yes

No

If yes, who do you know who is employed at Berkshire Place, 89 South or At Home with Berkshire Place?

Position Desired and Availability

Which position(s) interest you?(Required)

Date available

What hours are you to available to work?

Full-Time

Part-Time

Intern

What shifts are you available to work?

Days

Evenings

Nights

Are you legally authorized to work in the United States?(Required)

Yes

No

Are you at least 18 years of age?(Required)

Yes

No

Professional Licenses and/or Certifications

License or Certification 1: Type

License or Certification 1: Organization/State Issued

License or Certification 1: Date Issued

License or Certification 2: Type

License or Certification 2: Organization/State Issued

License or Certification 2: Date Issued

Education

High School Name

Location of High School

City State / Province / Region Country

Did you graduate high school?

High School Graduate

Earned GED

No

College or University Name

Location of College or University

City State / Province / Region Country

Did you graduate college or university?

Yes

No

Please list Scholastic Honors or Activities in High School or College:

Personal Reference 1:

Do not include former employers or relatives.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Personal Reference 2:

Do not include former employers or relatives.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Personal Reference 3:

Do not include former employers or relatives.

Name

First Last

Phone

Volunteer Experiences (skip if none)

Please list any verifiable volunteer experiences

Volunteer Organization 1: Name

Volunteer Organization 1: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Volunteer Organization 1: Phone

Volunteer Organization 1: Supervisor Name

First Last

Volunteer Organization 1: Position/Duties

Volunteer Organization 1: Start Date

Volunteer Organization 1: End Date

Volunteer Organization 2: Name

Volunteer Organization 2: Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Volunteer Organization 2: Phone

Volunteer Organization 2: Supervisor Name

First Last

Volunteer Organization 2: Position/Duties

Volunteer Organization 2: Start Date

Volunteer Organization 2: End Date

Employment History

Most Recent Employer Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Describe Your Duties

Reason for Leaving or Wanting to Leave

Start Date

End Date (Leave blank if still working here)

May we contact this employer as a reference?

Yes

No

Previous Employer Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Describe Your Duties

Reason for Leaving or Wanting to Leave

Start Date

End Date

May we contact this employer as a reference?

Yes

No

Employer Name:

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Position Held

Supervisor

First Last

Describe Your Duties

Reason for Leaving or Wanting to Leave

Start Date

End Date

May we contact this employer as a reference?

Yes

No

CERTIFICATION AND ASSENT:

I hereby certify that the statements I have made are true, and if I am subsequently employed by Berkshire Place, 89 South, and/or by At Home with Berkshire Place, I may be subject to discharge if they are found to be false. I also understand that employment and continued employment may be conditional upon the results of criminal background checks with the Massachusetts Criminal History Systems Board.

I voluntarily give Berkshire Place, 89 South, and/or At Home with Berkshire Place the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. If employed, I will be required to complete an Employment Verification Form (I-9) and provide satisfactory evidence of identity and eligibility for employment in the United States.

I also understand that if I am hired, my employment with Berkshire Place, 89 South, and/or with At Home with Berkshire Place will be at-will and may be terminated by any and/or all of the organizations or by me at any time and for any reason or for no reason. I understand that no documents or statements of Berkshire Place, 89 South and/or At Home with Berkshire Place will constitute a contract of employment that in any way limits their right to terminate employment at-will.

I hereby acknowledge that I have read the above statements and understand the same. (Initial below.)(Required)

Name

This field is for validation purposes and should be left unchanged.

Employment

A Great Place To Work

Application

Basic Information About Yourself

Position Desired and Availability

Professional Licenses and/or Certifications

Education

Personal Reference 1:

Personal Reference 2:

Personal Reference 3:

Volunteer Experiences (skip if none)

Employment History

CERTIFICATION AND ASSENT: