Date of Application Date Available

Location:

Privacy statement

Partners sites are Equal Opportunity Employers and prohibit discrimination and harassment of any kind. Partners is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Partners are based on business needs, job requirements and individual qualifications, without regard to race, color, sex, citizenship, ancestry, veteran status, religion or belief, age, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. Partners will not tolerate discrimination or harassment based on any of these characteristics.

I voluntarily give this institution 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. I consent to take the physical examination and such future physical examinations as may be required by this institution at such times and places as the institution shall designate. I understand than offer of employment may be contingent on passing the physician examination which relates to the essential duties I would be required to perform.

I understand that my employment is at will and that either party is free to terminate the employment relationship at any time without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form. If employed, I will be required to complete an Employment Verification From (I-9) and within three days show satisfactory evidence of identity and eligibility for employment.

I have read and affirm as my own the above statements. I agree

Personal Information

Name:

Mailing Address:

Email address: Phone Number:

Employment Desired

Position(s) applied for

Will you accept employment of: Full-time Part-time Casual/On-call

Are you 18 years of age or older? Yes No

Education

Highest grade completed:

	Name of School	Location	Completed	Type of Degree or Certificate Received
Grade School			Yes No
High School			Yes No
College			Yes No
Vocational or Business			Yes No
Professional Education			Yes No

Professional Licenses and/or Certifications

Type	Organization or State Issued	Date Issued	Number

Employment Record (list last or present position first) or present position first) or present position first)

Present and Former Employers	Dates Employed	Salary Range	Position and Duties
,	From: To:	Starting: Ending:

Present and Former Employers	Dates Employed	Salary Range	Position and Duties
,	From: To:	Starting: Ending:

Present and Former Employers	Dates Employed	Salary Range	Position and Duties
,	From: To:	Starting: Ending:

Personal References (Do not include Relatives or Former Employers)

Name and Occupation	Address	Phone Number

Signature of Applicant

I certify that all of the information on my application is true and accurate.

Electronic Signature:

Please enter the following characters and select Submit Application.