We are pleased that you are interested in applying for a position with our organization. At Home with Berkshire Place does not discriminate in hiring or employment on the basis of race, color, creed, national origin, religion, sex, sexual orientation, results of genetic testing, marital status or ancestry; or on the basis of age against those whose age is over 40; or on the basis of a disability not limiting the applicant's ability to perform the applied for job satisfactorily; or military status or status as a veteran, Vietnam Era Veteran, or being a member of the Reserves or National Guard. No question on this form is intended to secure information to be used for such discrimination. (In addition, 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 civil liability.)

We will give this application every consideration. However, in accepting it, our organization makes no commitment of employment to the applicant.

Personal Information

Section 1 - Availability

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Section 2 - Professional Licenses and/or Certifications

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Section 3 - Education: (Please list name of school)

Section 4 - Employment Verification

Section 5 - Personal References:(Do not list former employers)

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Section 6 - Volunteer Experiences:

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Section 7 - Employment History (Start with most recent)

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Section 8 - Employment History (Start with most recent)

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Section 9 - Employment History (Start with most recent)

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Section 10 - Employment History (Start with most recent)

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I hereby certify that the statments I have made are true, and if I am subsequently employed by At Home with Berkshire Place, I may be subject to discharge if they are found to be false. I also understand that employment and continued employment may be conditional upon the results of criminal background checks with the Massachusetts Criminal History Systems Board.

I voluntarily give this organization the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. Such investigation may include, but not be limited to license verification, multi-state nurse aide registry checks, and sex offender registry checks. I consent to take a physical examination and pre-employment drug testing, and such future physical examinations and drug testing as may be required by this organization. I understand that an offer of employment may be contingent on passing the physical examination which relates to the required essential duties of the position and/or goverment regulations. If employed, I will be required to complete an Employment Verification Form (I-9) and provide satisfactory evidence of identity and eligibility for employment in the United States.

I also understand that if I am hired, my employment with At Home with Berkshire Place will be at-will and may be terminated by the organization or me at any time and for any reason or for no reason. I understand that no documents or statments of At Home with Berkshire Place will constitute a contract of employment that in any way limits the organization's right to terminate employment at-will.

I hereby acknowledge that I have read the above statement and understand the same.