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Online Application

Thank you for your interest in working with our company. Please fill out the following form to apply for a position with us.

Equal Opportunity Employer
New England Home Health Care is an Equal Opportunity Employer and does not discriminate in hiring or employment on the basis of race, color, religion, sex, disability, age, national origin, ancestry, or any other classification protected by law.
Name*
First Last
Primary Phone*
Secondary Phone
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date Available to Start*
Date Format: MM slash DD slash YYYY
Are you 18 or older?*
- Yes
- No
Are you a U.S. citizen or an alien authorized to work in the U.S?*
- Yes
- No
Have you ever been known by any other name?*
- Yes
- No
If Yes, please list and explain.
Position Desired:*
- RN
- LPN
- CNA
- PCA/PSS
- DSP
- CRMA
- Office
Are you currently registered, licensed, or certified for the position desired?*
- Yes
- No
Days Available For Work*
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Hours Available*
Referred By*
- Agency
- Newspaper
- Facebook
- InDeed.com
- Website
- Radio
- Employee
- Other
Name of Referred by Employee/Other
Have you ever been convicted of a crime or pled guilty, "nolo", or no contest?*
- Yes
- No
Are you excluded from participating in any state of federal programs?*
- Yes
- No
If you responded "YES" to either question, please explain.
(New England Home Health Care conducts criminal record checks. Failure to divulge complete information will disqualify you from employment. Conviction of a crime does not disqualify the applicant from employment consideration.)
Do you have any relatives currently employed by NEHHC?*
- Yes
- No
Have you previously worked at NEHHC?*
- Yes
- No
Do you have adequate transportation?*
- Yes
- No
Do you have automobile liability insurance?*
- Yes
- No
Have you ever had any complaints or annotations against your professional license or certificate (or have anything pending) with a professional board of licensing/certification?*
- Yes
- No
Have you ever had a license or registry suspended or revoked?*
- Yes
- No
Education
Highest Degree Earned*
School Name*
School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Major Course/Subject*
Did you graduate?*
- Yes
- No
High School*
Outside Activities
Record of Employment
Beginning with your present or last position, list the last four jobs you have held, including a summary of experience, etc. (indicate military experience if job related). If you have a résumé, please attach to application.
Current Employer
Current Employer Name*
Type of Business*
Current Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date*
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Start Title*
Last Title*
Starting Salary*
Final Salary*
Supervisor Name*
First Last
Reason For Leaving
Brief Description of Duties
Number of Hours Worked Per Week
Previous Employer #1
Previous Employer Name
Type of Business
Previous Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Start Title
Last Title
Starting Salary
Final Salary
Supervisor Name
First Last
Reason For Leaving
Brief Description of Duties
Number of Hours Worked Per Week
Previous Employer #2
Previous Employer Name
Previous Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Type of Business
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Start Title
Last Title
Starting Salary
Final Salary
Supervisor Name
First Last
Reason for Leaving
Brief Description of Duties
Number of Hours Worked Per Week
Prior Relevant Experience
Summarize prior relevant experience and fill in periods of unemployment or periods not accounted for above.
Personal References
Name of Reference #1*
First Last
Phone of Reference #1*
Email of Reference #1
Name of Reference #2*
First Last
Phone of Reference #2*
Email of Reference #2
Name of Reference #3
First Last
Phone of Reference #3
Email of Reference #3
Statement
I hereby certify that the above information is correct and complete to the best of my belief. I make this statement with knowledge that any false or misleading statement or omission of material fact may result in dismissal. I understand any job offer by New England Home Health Care is conditioned upon: (1) Receipt of acceptable recommendations for reference; (2) Proof of U.S. Citizenship or appropriate visa or work permit; (3) Successful completion of a pre-placement physical examination, including substance abuse testing; (4) Review and approval of background checks including criminal history, driving record, state licensing/certification verification. I authorize an investigation, through whatever means deemed appropriate, of all statements contained in this application and all facts resulting from the investigation. I release from all liability all sources supplying such information. The employer is authorized to use any information obtained from its investigations to determine my suitability for employment. I release New England Home Health Care from any liability in connection with such investigation.
Please attach resume and cover letter:
Maximum File Size : 8MB

Online Application

Equal Opportunity Employer

Education

Record of Employment

Current Employer

Previous Employer #1

Previous Employer #2

Personal References

Statement