Work for NORESS Corporation | NORESS Corporation

NORESS Corporation Application for Employment

AN EQUAL OPPORTUNITY EMPLOYER
The policy of Center of Hope Foundation Inc. is to provide employment opportunities without regard to race, color, sex, religion, sexual orientation, marital status, veteran status, national origin, or age.

General

First Name*

Middle Initial*

Last Name*

Are you of or over 18 years of age?*

Yes

No

Address*
Full present address.

Street Address Apt, Suite, Bldg. (optional) City State / Province / Region ZIP / Postal Code Country

Address
Mailing address if different.

Street Address Apt, Suite, Bldg. (optional) City State / Province / Region ZIP / Postal Code Country

Phone*
Home phone number.

Phone
Cell phone number.

Email*

Email address

How did you hear about us?

Do you have the legal right to work in the US?*
(According to Federal Law, work authorization documentation will be required upon employment).

Yes

No

Have you filed an application with or been employed by this Agency before? If yes, give a date.
MM slash DD slash YYYY

Are you presently employed?*

Yes

No

May we contact your employer?*

Yes

No

When are you available to begin working?*
MM slash DD slash YYYY

What are you available to work?*

Full time

Part time

Summer

Are you on layoff and subject to recall?*

Yes

No

Do you possess a valid driver's license?*

Yes

No

Do you have daily access to a vehicle?*

Yes

No

Can you travel if you are assigned to another program site?*

Yes

No

Other forms of identification issued by the Commonwealth?

Indicate which foreign languages you speak, read and/or write
Answer only if your knowledge of a foreign language is related to the requirements of the position for which you are applying.

References

Give name, address and telephone number of three references who are not related to you, and are not previous employers.

Reference #1 - Name*

Address*

Phone Number*

Reference #2 - Name*

Address*

Phone Number*

Reference #3 - Name*

Address*

Phone Number*

Employment Experience

Start with your present or last job. Include military service assignments and any work performed on a volunteer basis.

Employer name #1*

Address

Phone number*

Job title*

Supervisor name*

Reason for Leaving*

Beginning date of employment*
MM slash DD slash YYYY

Ending date of employment*
MM slash DD slash YYYY

Untitled

Employer name #2*

Address

Phone number*

Job title*

Supervisor name*

Reason for Leaving*

Beginning date of employment*
MM slash DD slash YYYY

Ending date of employment*
MM slash DD slash YYYY

Untitled

Employer name #3*

Address

Phone number*

Job title*

Supervisor name*

Reason for Leaving*

Beginning date of employment*
MM slash DD slash YYYY

Ending date of employment*
MM slash DD slash YYYY

Untitled

Special Skills and Qualifications
Summarize special skills and qualifications acquired from employment or other experience that may be helpful in this new position.

Education

List the highest level of education you have received.

High School (or GED) Name

Year graduated

High School (or GED) Name

Year graduated

Other education or training
Please describe.

Additional

CORI Guidelines
101 CMR 15.03; 15.06, 15.07, 15.08, 15.09, 15.10, 15.12, 15.15 Criminal History Information shall be required and considered only after a conditional offer of employment has been offered; applicants and employees seeking positions where a criminal background is relevant; potential for unsupervised contact with Center of Hope Foundation (CoHF) program clients; current employees; or others for whom a CORI is necessary to comply with other legal requirements, or have a potential for contact with a CoHF client when no other CORI cleared employee is present. The Hiring Authority will inform the provisional candidate that his or her CORI may be utilized by qualified mental health professionals, conducting themselves in accordance with CMR 15.09 and by EOHHS, & EOHHS Agencies, or vendor program personnel.
Self Declaration of a Disability:
In accordance with Executive Order #227, the Governor’s Code of Fair Practice and Executive Order #246 Affirmative Action Program for the Handicapped, each employee and applicant is invited to indicate whether he/she is handicapped, for the purpose of receiving affirmative action benefits of protected status. This information is intended for use solely in connection with the Commonwealth’s Affirmative Action efforts. It is being requested in a voluntary basis, and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and used only in accordance with the State Office of Affirmative Action Guidelines and any Federal regulations.
You will qualify for protected status if you (1) have a physical or mental impairment which substantially limits one or more major life activities, or (2) have a record of such impairment.
If you would like to declare a disability as stated above, indicate so here and complete the Self Identification Form.

I would like to complete the Self Identification Form declaring a disability*

Yes

No

EQUAL EMPLOYMENT OPPORTUNITY SELF-DISCLOSURE FORM
NESS/NORESS Corporation is an affirmative action/equal opportunity employer. In order to meet State and Federal requirements, it is necessary to collect information concerning applicants. All responses are completely voluntary and refusal to respond will not result in the adverse treatment of any applicant. This information will not in any way be used for employment decisions and will not be seen by those making hiring decisions. Although completion of this information is optional, your reply is greatly appreciated.

First Name

Last Name

Sex

Male

No

Position applied for:

Ethnic Oirigin
Please select all that apply.
WHITE (Not of Hispanic Origin) - A person having origins in any of the original people of Europe, North Africa or the Middle East.
BLACK (not of Hispanic Origin) - A person having origins in any of the Black racial groups of Africa.
HISPANIC - A person of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of race.
ASIAN OR PACIFIC ISLANDER - A person having origins in any of the original peoples of the Far East, Southwest Asia, the Indian Subcontinent, or the Pacific Islands. The area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa.
AMERICAN INDIAN OR ALASKAN NATIVE - A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition.

Please check all that describe your Veteran status, if any:
DISABLED VETERAN - (1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) A person who was discharged or released from active duty because of a service-connected disability.
RECENTLY SEPARATED VETERAN - any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U. S. military, ground, naval or air service.
ARMED FORCES SERVICE MEDAL VETERAN - any veteran who, while serving on active duty in the U. S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985....
OTHER PROTECTED VETERAN – a veteran who served on active duty in the U. S. military, ground, navel or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administrated by the Department of Defense.

Resume & Cover Letter

Please upload your resume.
Max. file size: 50 MB.

Please upload your cover letter.
Max. file size: 50 MB.

Agreement

It is my understanding that this employment application, or the granting of a verbal interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that if hired, my employment will be “at will” in nature, and may be terminated with or without cause at any time, by either my-self, or my employer. I also understand that this written statement supersedes any and all verbal representations made by agents or representatives of this agency or organization. I certify that the information on this application is true, complete and correct. I authorize NESS/NORESS Corporation to investigate my past employment, education and activities and I release from all liability all persons, companies and corporations supplying such information. I understand that false answers, statements or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.

Signature*

Date
MM slash DD slash YYYY

Verification

Please enter any two digits*
Example 12

Employment Opportunities

NORESS Corporation Application for Employment

NORESS Corporation Application for Employment

General

References

Employment Experience

Education

Additional

Resume & Cover Letter

Agreement

Verification