Apply Online Job Application We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in possible future positions. Step 1 of 5 20% Health Affiliates Maine is an Equal Opportunity Employer. We provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.Name* First Last Home Phone*Cell PhonePresent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Previous Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Position(s) applied for:If you are applying to a position that has a location other than our Auburn, Maine office, please list that location in the box below.How did you hear about this position vacancy?*Indeed.comME Job Link Career CenterWebsiteTrainingFacebookFriendEmployeeSeminarOtherPlease chooseWhat is the name of the employee?OtherWere you previously employed with us?YesNoIf yes, when? Date Format: MM slash DD slash YYYY If your application is considered favorably, on what date will you be available for work?* Date Format: MM slash DD slash YYYY Have you been convicted of a crime in the past ten years?*YesNoIf yes, please describe in full:Are you authorized to work in the United States?*YesNoProof of authorization will be required upon employment. EducationHigh School:Did you graduate high school?YesNoCheck the last year completed 9 10 11 12 Which did you acquire?GEDDiplomaCollege and Course of Study:Check the last year completed 1 2 3 4 Did you graduate college?YesNoList of Degrees:Post Graduate or Other Degrees: Military Service RecordWhere you in the Armed Forces?YesNoIf yes, what branch?Please make a selectionAir Force and Air Force ReserveAir National GuardArmy and Army ReserveArmy National GuardCoast Guard and Coast Guard ReserveMarine Corps and Marine Corps ReserveNavy and Navy ReserveDates of active duty:Please provide date range: mm/dd/yy - mm/dd/yyDischarge rank and type.Please provide both rank and type.Clinical Applicants:Are you a clinical applicant?YesNoHas your professional license to practice ever been suspended or revoked?YesNoIf yes, please explain: Work History:List below all present and past employment, beginning with your most recent position held.Name and address of current employerPhoneDates employed:Please provide date range: mm/dd/yy - mm/dd/yyPositions HeldReason for LeavingName of SupervisorName and address of previous employerPhoneDates employed:Please provide date range: mm/dd/yy - mm/dd/yyPositions HeldReason for LeavingName of SupervisorName and address of previous employerPhoneDates employed:Please provide date range: mm/dd/yy - mm/dd/yyPositions HeldReason for LeavingName of SupervisorMay we contact the employers listed above?YesNoIf no, indicate by name which one(s) you do not wish us to contact:Resume:Please upload your cover-letter, resume and references: Drop files here or Applicant Information ReleaseI hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold Health Affiliates Maine, any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information important to the employment process.To the best of my knowledge and belief, the facts set forth above in my application for employment are true and complete. I understand that if employed, false statements on this application shall be considered sufficient cause for dismissal. As employment is "at will", nothing in this application should be construed to limit the Employer's right to terminate me with or without cause or notice.Please provide your e-signiture.Date Date Format: MM slash DD slash YYYY Date application submitted.