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NEHHS is currently hiring – FLEXIBLE HOURS - RNS / LPNS – MANY LOCATIONS!

Employment Application

Employment Application

Step 1 of 5

20%

Position ID
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Emergency contact name*
First Last
Emergency contact phone number*
How long have you lived at your current address?*
Have you ever been convicted of a crime?*
- Yes
- No
Please explain:*
Have you ever been involved as defendant in a malpractice suit?*
- Yes
- No
Please explain:*
How did you hear about us?*
Name of client who referred you*
Name of employee who referred you*
Resume Upload
Please upload your resume here

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Which of the following positions are you interested in working in (please check all that apply)?*
- Private Duty Nursing
- Skilled Visits
- CHHA/CNA
- Homemaker/Companion
- Nite Nannie
Assignment preferences*
- Full Time
- Part Time
- Visits
- Flu Clinics
- Office
MA Nursing License
MA Nursing License Expiration Date
Date Format: MM slash DD slash YYYY
NH Nursing License
NH Nursing License Expiration Date
Date Format: MM slash DD slash YYYY
RI Nursing License
RI Nursing License Expiration Date
Date Format: MM slash DD slash YYYY
MA C.N.A. License
MA C.N.A. License Expiration Date
Date Format: MM slash DD slash YYYY
NH C.N.A. License
NH C.N.A. License Expiration Date
Date Format: MM slash DD slash YYYY
RI C.N.A. License
RI C.N.A. License Expiration Date
Date Format: MM slash DD slash YYYY
Do you have malpractice insurance?*
- Yes
- No
Company Name*
Policy Number

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Education
High School Name*
Degree*
- Diploma
- GED
College Name*
Degree*
Have you taken a training or certification program?*
- Yes
- No
Name of institution or school*
Name of certificate*
Certificate number*
Certificate expiration date*
Date Format: MM slash DD slash YYYY

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Work History
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Job Title*
Supervisor's Name*
First Last
Reason for Leaving*
Start Date*
Date Format: MM slash DD slash YYYY
Current employed at this job?*
- Yes
- No
End Date*
Date Format: MM slash DD slash YYYY
Additional Work History
Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone
Job Title*
Supervisor's Name*
First Last
Reason for Leaving*
Start Date*
Date Format: MM slash DD slash YYYY
Current employed at this job?*
- Yes
- No
End Date*
Date Format: MM slash DD slash YYYY

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Authorization
I authorize investigations of all statements and /or references contained in this application. I understand that misrepresentation or omission of facts called for is cause for immediate dismissal. Further, I understand that my employment is at will for no definite period and may, regardless of the date of payment of my wages and salary, be terminated without cause at any time without previous notice. I will submit proof of a valid TB screen or allow the screen to be done by the company. I understand that this application is valid only for the period of 6 months and I may not accept employment from company clients for a period of three months after separation.
Signature*
Name*
First Last
Phone
This field is for validation purposes and should be left unchanged.

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Get In Touch

594 Marrett Road, Lexington, MA

[email protected]

Additional Resources

Employee Portal

About Us

New England Home Health Services offers continuous skilled nursing from 3 hours to 24 hours as authorized by your insurer, as well as nursing visits, home health aide assistance and therapy services. We serve all of Greater Boston and much of the suburbs.

© 2017 New England Home Health Services. All Rights Reserved.

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