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Please follow the instructions for each section and complete this application thoroughly and accurately. An incomplete application will not be considered. If you need more room for any item, continue on a separate piece of paper. PVH is committed to complying with all federal and Maine laws, including, but not limited to, laws regarding access to medical services, ethical delivery of patient care, and non-discrimination in employment. Consistent with the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, the Vietnam Era Veterans Readjustment Assistance Act of 1974, and the Maine Human Rights Act, an applicant may request accommodations needed to participate in the application process. No question on this application is intended to secure information to be used for unlawful purposes.

Personal Information

First Name
Last Name
Email
Phone
Alt Phone
Work Phone
Address
City
State
Zip
Preferred Job Type



Preferred Shift



I Would you consider other shifts
When Can You Start
Desired Salary
Are You Currently Employed
May We Contact Your Employer

Please Consider Me for the Following Positions as Well















Employment History

List each of your previous employers, last (or current) position first. Explain any lapses in employment. Please provide full contact information, including address and phone number. An application without sufficient contact information will be considered incomplete.
Employer 1 (Most Recent)
Employer Name
Phone
Start Date
End Date
Address, City, State, Zip
May We Contact This Employer
Job Title
Salary Range (start - end)
Supervisor's Name
Reason for Leaving
Employer 2
Employer Name
Phone
Start Date
End Date
Address, City, State, Zip
May We Contact This Employer
Job Title
Salary Range (start - end)
Supervisor's Name
Reason for Leaving
Employer 3
Employer Name
Phone
Start Date
End Date
Address, City, State, Zip
May We Contact This Employer
Job Title
Salary Range (start - end)
Supervisor's Name
Reason for Leaving

Education Background

High School Name
High School Location
Name Used in HS if DIfferent than above
Did you Graduate High School
College
Degree
OtherEducationInfo

Licenses

Type


Issue Date


Number


Expiration


Millitary

Millitary Branch
Discharge Date
Rank at Discharge
Type of Discharge
ApplicableTraining

Other Information

Please be accurate. An affirmative answer in this section does not necessarily restrict your eligibility for employment. An application lacking a response to these questions will be considered incomplete. Giving false or misleading information will void the application and nullify a job offer.
Is your eligibility for employment in the USA restricted?
If Yes Explain
Have you ever been convicted of a crime?
Offense Details
PVH has a policy restricting the employment of certain relatives in certain situations. Is anyone in your family currently employed by PVH? Please don’t provide a name. We will ask for that detail if it becomes pertinent.

Personal References

List at least two (more are better) who can speak to your integrity and other personal qualities, with adequate contact information. For Business/Profession or Relationship, consider why each person would be credible.
Reference 1
Full Name
Address
Business
Phone
About
Relationship
Years Known
Reference 2
Full Name
Address
Business
Phone
About
Relationship
Years Known
Reference 3
Full Name
Address
Business
Phone
About
Relationship
Years Known

Resume/CV

Resume Title
Resume
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Cover Note

Attestation - Please read this statement carefully and sign below after you completely understand it.

I understand that Penobscot Valley Hospital is dedicated to providing superior medical services with equal care and compassion shown to all, and requires that its employees share this commitment. I realize that every job at PVH contributes to achieving this objective. I understand that the minimum requirements for employment include but are not limited to: minimum age 18, high school diploma or GED, evidence of functional literacy, degree or license or certification for certain jobs, evidence of qualities that help PVH meet public expectations for customer service, and the ability to do the essential elements of the job. I understand that this application will remain active for six months from the date submitted. After that time, if I still want to be considered for employment, I must submit a new application. I understand that I may not receive a reply to this application and that an interview does not constitute an offer of employment unless an authorized manager at PVH makes such an offer directly. I certify that all of the statements contained in this application and any accompanying documents are true and complete. I understand that any offer of employment is conditioned on a background check. I hereby authorize Penobscot Valley Hospital to investigate all statements contained in my application and accompanying documents, and to contact employers, schools, and individuals named herein (except my current employer, if so noted). I release those contacted from all liability for damage in providing or declining to provide information. I understand that any false statements, omissions, or misrepresentations by me will constitute sufficient cause and reason either for PVH’s refusal to hire or decision to terminate employment. I understand and agree that, unless otherwise expressly agreed to in writing signed by an administrative official of PVH, if employed by the PVH in a non-union position, my employment will be at will and without fixed term, and that either of us may terminate the employment at any time with or without prior notice or cause. I also understand that this at-will employment relationship may not be altered or amended, except with regard to changes in compensation or representation. If I am employed in a position subject to collective bargaining, my employment will be governed by the terms of a collective bargaining agreement once I become eligible for bargaining unit membership. If extended an offer of employment, I consent to undergo a pre-placement physical examination by a health professional selected by PVH, which may include blood and urine testing. I understand that any offer of employment is conditioned upon the results of this post-offer examination. I also understand that PVH has a policy restricting employment of those who are relatives of current employees and that any job offer arising out of this application is subject to that policy. I am aware that Penobscot Valley Hospital, a Critical Access Hospital located in Lincoln, Maine, is an equal opportunity employer. As such, except where required by state or federal law, PVH does not discriminate in hiring, promotion, retention, or termination on the basis of race, color, religion, gender, national origin, disability real or perceived, sexual orientation, genetic predisposition, or veteran status.
 
 
I agree To the PVH Employee Standards. Click Here to view our standards
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