HRApplication

Are You Applying for the SPED Teacher position?

Yes No Job Code Number: View Job Description

PERSONAL

First Name:

Last Name:

Middle Int.:

E-Mail:

Address line 1:

Address line 2:

City:

State:

Zip:

Years at address:

Telephone (Home) :(ex: 978-224-0000)

Telephone (Work):(ex: 978-224-0000)

May we contact work?

YES NO

Drivers License State

SSN RMV#

Are you over 21?

YES NO

Are you prevented from lawfully becoming employed due to a visa or immigration status?

YES NO

**GENERAL**
Have you ever applied for employment with Seven Hills Foundation	YES NO
If Yes,

How did you here about Seven Hills

Newspaper	Employee	Billboard
Web Site	Internet Search	Other Internet
Job Fair	DET or CC	Job Find.com
Walkin	Other

if other describe:

**JOB INTEREST**
If you have not indicated a specific job above (indicated by Job Code #), What type of employment are you looking for?	link to enter Job Code number Desired Wage
Full Time	Part time
Preferable Work Times:
Specify hours and days you CANNOT work:
Are you willing to to work EVERY Saturday and Sunday?	YES NO
Data available to start:

**EDUCATION**

**High School or GED**
Name of School
Address / City
State
Zip

Graduated	YES NO
GED	YES NO
Major / Specialty:

**College or University**
Name of School
Address / City
State
Zip

Graduated	YES NO
Major / Specialty:

**Special Training or Other**
Name of School
Address / city
State
Zip

Graduated	YES NO
Major / Specialty:

.
Last year of Education completed:
if other:

**EMPLOYMENT REFERENCES** (3 Work related)

**Reference 1**
Name (First & Last)
Address
City
State
Zip
Telephone	(ex: 978-224-0000)
Occupation

**Reference 2**
Name (First & Last)
Address
City
State
Zip
Telephone	(ex: 978-224-0000)
Occupation

**Reference 3**
Name (First & Last)
Address
City
State
Zip
Telephone	(ex: 978-224-0000)
Occupation

.
Have you ever been convicted of a felony in the past seven (7) years?	Yes No

Such a conviction may be relevant, if job-related, but does not bar you from employment. If you have been convicted of a felony, please explain below:

WORK EXPERIENCE (List, in order, your last three work experience)

**Employer 1**
Name of EMPLOYER
Address
City
State
Zip
Telephone	(ex: 978-224-0000)
Job title
Date Started:	(mm/dd/yy)
Starting pay: (numbers only)	Yr Hour
Date left:	(mm/dd/yy)
Final pay: (numbers only)	Yr Hour
Supervisor's Name:
Supervisor's Title:
Describe your major duties:
Full Time	Part Time
Number of employees supervised by you:
Reason for leaving

**Employer 2**
Name of EMPLOYER
Address
City
State
Zip
Telephone	(ex: 978-224-0000)
Job title
Date Started:	(mm/dd/yy)
Starting pay: (numbers only)	Yr Hour
Date left:	(mm/dd/yy)
Final pay: (numbers only)	Yr Hour
Supervisor's Name:
Supervisor's Title:
Describe your major duties:
Full Time	Part Time
Number of employees supervised by you:
Reason for leaving

**Employer 3**
Name of EMPLOYER
Address
City
State
Zip
Telephone	(ex: 978-224-0000)
Job title
Date Started:	(mm/dd/yy)
Starting pay: (numbers only)	Yr Hour
Date left:	(mm/dd/yy)
Final pay: (numbers only)	Yr Hour
Supervisor's Name:
Supervisor's Title:
Describe your major duties:
Full Time	Part Time
Number of employees supervised by you:
Reason for leaving

Are Your education or employment records under any other name

Yes No

List any licenses (including driver's license), certification or registration you possess:

License	License Number	Date Issued	Expiration Date
		(mm/dd/yy)	(mm/dd/yy)
		(mm/dd/yy)	(mm/dd/yy)
		(mm/dd/yy)	(mm/dd/yy)
		(mm/dd/yy)	(mm/dd/yy)
		(mm/dd/yy)	(mm/dd/yy)

**APPLICANT VERIFICATION of DEGREE**
Seven Hills Foundation and its subsidiaries require verification of academic degree for individuals assuming positions requiring degrees. I understand the Seven Hills Foundation or any of its subsidiaries cannot offer me a position without proper verification of my academic degree(s) when I apply for any position under the conditions described in the policy. e-Signature: Date: (mm/dd/yy)

**OTHER EXPERIENCE**
Please describe any relevant personal or professional experience which you would consider of value and which may assist us in considering your application for employment. Verified work performed on a volunteer basis may be included.


It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's services if I have been employed. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representative for seeking such information and all other persons, corporations or organizations for furnishing such information. e-Signature: Date:(mm/dd/yy)

Please submit your Email Address again:

**Please Check all Job Categories that interest you and that you believe best fit your qualifications**
Administrative	Health Care	Residential Adult Supports
Day Program	Maintenance	Residential Children's Supports
Direct Support	MIS (Computer Technology)	Social Services
Educational Supports	Nursing or CNA	Therapy Services
Family Support

CORI REQUEST FORM

All applicants shall complete an application form that contains a section requiring the applicant to disclose whether or not he or she has a criminal record and what crimes, if any, he or she has been convicted of, consistent with the requirements of M.G.L. c. 151B, §4 (9). No application for employment shall be considered complete unless the applicant completes a successful CRIMINAL OFFENDER RECORD CHECK.

Seven Hills Foundation has been certified by the Criminal History System Board for access to conviction and pending criminal case data. As an applicant / employee for Seven Hills, I understand that a criminal record check will be conducted for conviction and pending criminal case information only and that it will not necessarily disqualify me. The application information I have provided Seven Hills is correct to the best of my knowledge.

A CORI form will be completed when and if an interviewed is scheduled.

I agree to allow Seven Hills Foundation to conduct a CORI background check.

I do NOT agree to allow Seven Hills Foundation to conduct a CORI background check.

Failure to agree to a CORI check will result in disqualification of Application.

It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's services if I have been employed. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the employer and its representative for seeking such information and all other persons, corporations or organizations for furnishing such information.

e-Signature: Date:(mm/dd/yy)

Field for Office use only

Click here and you are done -->>