Northern Maine General (Application for Employment)

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PLEASE READ THIS APPLICATION THOROUGHLY AND COMPLETE IT HONESTLY. NORTHERN MAINE GENERAL PERFORMS A DETAILED BACKGROUND INVESTIGATION ON ALL FINAL CANDIDATES.

IMPORTANT NOTICE: Northern Maine General is an equal opportunity employer and will not discriminate against any employee or applicant for employment in any manner prohibited by law. If you feel you have been unfairly treated or discriminated against for any reason, please call this to the attention of Jocelyn Haley, Equal Opportunity Officer (EOO), so that we may address your concerns.

Employment is conditioned on the successful completion of the screening process (interviews, background checks, reference checks). By signing this application, I represent that the information provided in this form is given voluntarily and may be used in filing reports required by state and federal governments and agencies and for any other purpose not prohibited by law.
EMPLOYMENT INFORMATION
1. Position applying for (one per application) *

Enter the position you are applying for.
Type of employment desired? *
Full Time Part Time Temporary
Check off each that applies.
How were you referred to NMG? *
Referred by NMG Employee
Name the other Referral Source
PERSONAL DATA
2. Applicant's Full Name * First Middle Last
3. Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
4. Primary Telephone Number * - ### - ### ####
Email address
5. Have you ever been convicted of a crime, had a criminal charge filed, or pled nolo contendere to a crime? *

5. Have you ever been convicted of a crime, had a criminal charge filed, or pled nolo contendere to a crime? Yes No
If yes, please state the circumstances with regard to each.
*NOTE: Answering “Yes” to this question may not necessarily disqualify you from the position desired. Each action and explanation will be weighed/considered in relationship to the position for which you are applying.
6. Have you been employed by Northern Maine General (any division) before? *

6. Have you been employed by Northern Maine General (any division) before? Yes No
If so, please set forth all positions held, dates of employment in each division, and reason(s) for leaving
7. Can you, after employment, submit verification of your legal right to work in the United States? *

7. Can you, after employment, submit verification of your legal right to work in the United States? Yes No
8. Please explain, in your own words, why you want to work at Northern Maine General, in what position(s), and any other information you feel should be considered in connection with your employment application: *
Do you have a resume to upload? *

Do you have a resume to upload? Yes No

Northern Maine General (Application for Employment)

Northern Maine General (Application for Employment)

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EMPLOYMENT INFORMATION

PERSONAL DATA

*NOTE: Answering “Yes” to this question may not necessarily disqualify you from the position desired. Each action and explanation will be weighed/considered in relationship to the position for which you are applying.