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BAY COVE APPLICATION FOR EMPLOYMENT

If, for any reason, you do not view a confirmation page after submitting this application for employment, please call (617) 371-3000.
 
You will be able to upload your resume in the next step of the application process once the application has been successfully completed.
 
We consider applications for all positions without regard to age, race, color, religious creed, national origin, sex, sexual orientation, criminal record, mental illness, handicap/disability, or any other legally protected status pursuant to Massachusetts Fair Employment Practices Act, and other relevant federal, state and local laws. Those applicants requiring reasonable accommodation to the application and/or interview process should notify Human Resources.

* - Denotes REQUIRED field.

           
* Position Desired 1:
* Last Name:     * First Name:    Middle Name:
* Address 1: * Telephone # 1: * Type:
Address 2:   Telephone # 2:    Type:
* City:     * State:     * Zip Code: * Email:
If you are under 18, and it is required, can you furnish a work permit?
If no, please explain:
* Have you ever been employed by Bay Cove before?
If yes, give dates and positions:
* Are you legally eligible for employment in this country?
* Date available for work (m/d/yyyy): What is your desired salary range?
* Type of employment desired:
* Do you have a valid MA Driver's License?    License #:    State (if other than MA):
VOLUNTARY SELF-IDENTIFICATION (OPTIONAL)
* Yes, I wish to participate in the Voluntary Self-Identification Survey
* No, I do not wish to participate in the Voluntary Self-Identification Survey
Gender:

* Race/Ethnicity: (Please check one of the descriptions below corresponding to the group with which you identify.)
View Race/Ethnicity Definitions
American Indian or Alaska Native (not Hispanic or Latino)
Asian (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Hispanic or Latino
Two or More races (not Hispanic or Latino)
White (not Hispanic or Latino)

Veteran Status:
I wish to identify myself as (please check all that apply) View Veteran Status Definitions
Disabled Veteran
Recently Separated Veteran
Armed Forces Service Medal Veteran
Other Protected Veteran
EMPLOYMENT HISTORY
Provide the following information for your past three (3) employers, assignments or volunteer activities starting with the most recent.
* From * To * Employer: * Telephone #:
* Starting Job Title: * Address:
* Ending Job Title: * Summarize the Nature of Work Performed and Job Responsibilities:
* May we contact?
* Reason for Leaving: * Starting Pay Rate:     * Final Pay Rate:
* From * To * Employer: * Telephone #:
* Starting Job Title: * Address:
* Ending Job Title: * Summarize the Nature of Work Performed and Job Responsibilities:
* May we contact?
* Reason for Leaving: * Starting Pay Rate:     * Final Pay Rate:
* From * To * Employer: * Telephone #:
* Starting Job Title: * Address:
* Ending Job Title: * Summarize the Nature of Work Performed and Job Responsibilities:
* May we contact?
* Reason for Leaving: * Starting Pay Rate:     * Final Pay Rate:
All candidates that are offered and accept a position will be subject to a Criminal Offender Record Information (CORI) review. A job offer and subsequent continued employment is contingent upon an acceptable CORI per MA State law.
LANGUAGES SPOKEN FLUENTLY
* (check all that apply):
English Spanish Haitian-Creole Portuguese
Russian Chinese Vietnamese Italian
Cape Verde American Sign Language Other
SKILLS AND QUALIFICATIONS
Summarize any pertinent training you have completed, skills you possess including computer, bilingual capabilities that may qualify you as being able to perform job-related functions in the position for which you are applying.
     SKILL/QUALIFICATION  DESCRIPTION
1.
CREDENTIALS
Type: License #: Expiration Date:
National Provider Identifier (NPI) #: If not known, go to: https://nppes.cms.hhs.gov
EDUCATIONAL BACKGROUND
* Highest Level of Education Attended:
NAME LOCATION # YRS
COMPLETED
DID YOU
GRADUTATE?
COURSE OF
STUDY / MAJOR
DEGREE
High School
College
Other
PROFESSIONAL REFERENCES
NAME TITLE TELEPHONE # # OF YRS KNOWN
* * *
* * *
* * *
* How did you hear about employment opportunities with Bay Cove?
If you were referred by a Bay Cove Employee, please list Employee name here:
APPLICANT STATEMENT

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s services, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that any employment relationship with this organization is of an "at will" nature. I am free to resign at any time with or without cause and without prior notice and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

DO NOT SUBMIT APPLICATION UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
* I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.
Please store my information on this computer. I may come back to apply for other positions.
DO NOT CHECK THE ABOVE BOX IF YOU ARE ON A SHARED COMPUTER!
* By entering the first initials of your first and last names in this box you acknowledge this to serve as your electronic signature. Furthermore, you are confirming that the information submitted in this application for employment is correct and accurate to the best of your knowledge.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment.
An employer who violates this law shall be subject to criminal penalties and civic liability.
BAY COVE HUMAN SERVICES, INC. IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER