Employment Opportunities NORESS Corporation Application for Employment NORESS Corporation Application for EmploymentAN EQUAL OPPORTUNITY EMPLOYER The policy of Center of Hope Foundation Inc. is to provide employment opportunities without regard to race, color, sex, religion, sexual orientation, marital status, veteran status, national origin, or age.GeneralFirst Name* Middle Initial* Last Name* Are you of or over 18 years of age?* Yes No Address*Full present address. Street Address Apt, Suite, Bldg. (optional) City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country AddressMailing address if different. Street Address Apt, Suite, Bldg. (optional) City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Home phone number.PhoneCell phone number.Email* Email addressHow did you hear about us?FriendRelativeNewspaperWalk-inOtherDo you have the legal right to work in the US?*(According to Federal Law, work authorization documentation will be required upon employment). Yes No Have you filed an application with or been employed by this Agency before? If yes, give a date. MM slash DD slash YYYY Are you presently employed?* Yes No May we contact your employer?* Yes No When are you available to begin working?* MM slash DD slash YYYY What are you available to work?* Full time Part time Summer Are you on layoff and subject to recall?* Yes No Do you possess a valid driver's license?* Yes No Do you have daily access to a vehicle?* Yes No Can you travel if you are assigned to another program site?* Yes No Other forms of identification issued by the Commonwealth? Indicate which foreign languages you speak, read and/or writeAnswer only if your knowledge of a foreign language is related to the requirements of the position for which you are applying. ReferencesGive name, address and telephone number of three references who are not related to you, and are not previous employers.Reference #1 - Name* Address* Phone Number*Reference #2 - Name* Address* Phone Number*Reference #3 - Name* Address* Phone Number*Employment ExperienceStart with your present or last job. Include military service assignments and any work performed on a volunteer basis.Employer name #1* Address Phone number*Job title* Supervisor name* Reason for Leaving* Beginning date of employment* MM slash DD slash YYYY Ending date of employment* MM slash DD slash YYYY Untitled Employer name #2* Address Phone number*Job title* Supervisor name* Reason for Leaving* Beginning date of employment* MM slash DD slash YYYY Ending date of employment* MM slash DD slash YYYY Untitled Employer name #3* Address Phone number*Job title* Supervisor name* Reason for Leaving* Beginning date of employment* MM slash DD slash YYYY Ending date of employment* MM slash DD slash YYYY Untitled Special Skills and QualificationsSummarize special skills and qualifications acquired from employment or other experience that may be helpful in this new position. EducationList the highest level of education you have received.High School (or GED) Name Year graduated High School (or GED) Name Year graduated Other education or trainingPlease describe.AdditionalCORI Guidelines 101 CMR 15.03; 15.06, 15.07, 15.08, 15.09, 15.10, 15.12, 15.15 Criminal History Information shall be required and considered only after a conditional offer of employment has been offered; applicants and employees seeking positions where a criminal background is relevant; potential for unsupervised contact with Center of Hope Foundation (CoHF) program clients; current employees; or others for whom a CORI is necessary to comply with other legal requirements, or have a potential for contact with a CoHF client when no other CORI cleared employee is present. The Hiring Authority will inform the provisional candidate that his or her CORI may be utilized by qualified mental health professionals, conducting themselves in accordance with CMR 15.09 and by EOHHS, & EOHHS Agencies, or vendor program personnel. Self Declaration of a Disability: In accordance with Executive Order #227, the Governor’s Code of Fair Practice and Executive Order #246 Affirmative Action Program for the Handicapped, each employee and applicant is invited to indicate whether he/she is handicapped, for the purpose of receiving affirmative action benefits of protected status. This information is intended for use solely in connection with the Commonwealth’s Affirmative Action efforts. It is being requested in a voluntary basis, and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and used only in accordance with the State Office of Affirmative Action Guidelines and any Federal regulations. You will qualify for protected status if you (1) have a physical or mental impairment which substantially limits one or more major life activities, or (2) have a record of such impairment. If you would like to declare a disability as stated above, indicate so here and complete the Self Identification Form.I would like to complete the Self Identification Form declaring a disability* Yes No EQUAL EMPLOYMENT OPPORTUNITY SELF-DISCLOSURE FORM NESS/NORESS Corporation is an affirmative action/equal opportunity employer. In order to meet State and Federal requirements, it is necessary to collect information concerning applicants. All responses are completely voluntary and refusal to respond will not result in the adverse treatment of any applicant. This information will not in any way be used for employment decisions and will not be seen by those making hiring decisions. Although completion of this information is optional, your reply is greatly appreciated.First Name Last Name Sex Male No Position applied for: Ethnic OiriginPlease select all that apply. WHITE (Not of Hispanic Origin) - A person having origins in any of the original people of Europe, North Africa or the Middle East. BLACK (not of Hispanic Origin) - A person having origins in any of the Black racial groups of Africa. HISPANIC - A person of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of race. ASIAN OR PACIFIC ISLANDER - A person having origins in any of the original peoples of the Far East, Southwest Asia, the Indian Subcontinent, or the Pacific Islands. The area includes, for example, China, Japan, Korea, the Philippine Islands, and Samoa. AMERICAN INDIAN OR ALASKAN NATIVE - A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition. Please check all that describe your Veteran status, if any: DISABLED VETERAN - (1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) A person who was discharged or released from active duty because of a service-connected disability. RECENTLY SEPARATED VETERAN - any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U. S. military, ground, naval or air service. ARMED FORCES SERVICE MEDAL VETERAN - any veteran who, while serving on active duty in the U. S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.... OTHER PROTECTED VETERAN – a veteran who served on active duty in the U. S. military, ground, navel or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administrated by the Department of Defense. Resume & Cover LetterPlease upload your resume.Max. file size: 50 MB.Please upload your cover letter.Max. file size: 50 MB.AgreementIt is my understanding that this employment application, or the granting of a verbal interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that if hired, my employment will be “at will” in nature, and may be terminated with or without cause at any time, by either my-self, or my employer. I also understand that this written statement supersedes any and all verbal representations made by agents or representatives of this agency or organization. I certify that the information on this application is true, complete and correct. I authorize NESS/NORESS Corporation to investigate my past employment, education and activities and I release from all liability all persons, companies and corporations supplying such information. I understand that false answers, statements or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.Signature* Date MM slash DD slash YYYY VerificationPlease enter any two digits* Example 12 Δ
