Career

Apply today for one of our RN, LPN, Physical Therapy, Occupational Therapy, or staff-aid positions

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    Newspaper AdWalk-inAgencySchoolEmployee

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    YesNo

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    Indicate the position for which you are applying:*

    Type of employment desired:*

    Shift desired:*

    Day Time‎Evening‎

    Salary desired:

    When can you start:

    Have you ever worked for this company before?*

    YesNo

    If yes, please specify date, facility/division and location:

    Have you ever applied for employment with this company before?*

    YesNo

    If yes, please specify date, facility/division and location:

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    EDUCATION:

    Choose the level of schools you've attended*

    High School‎CollegeGraduate School‎Trade/Business School‎other

    List the names and addresses for all schools attended, include your Major or Course of Study, indicate whether or not you graduated and identify your degree(s) earned.

    Subjects of special study or research work:

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    MISCELLANEOUS:

    Were you in the U.S. Armed Forces?*

    YesNo

    If yes, which branch?

    What were the dates of duty:

    What was your rank at separation?

    Briefly describe your duties:
    Note: This company does not discriminate on the basis of National Guard or Reserve Unit Duty obligations.

    Please list any other information you think would be helpful to us in considering you for employment, such as organizations, activities, accomplishments, computer skills, etc. Exclude all information indicative of race, color, religion, sex, sexual orientation, ancestry, national origin, age, disability, handicap or genetics.

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    EMPLOYMENT HISTORY:

    List the names of all your employers, past and present (you may list volunteer positions as well as paid positions, if you wish). Begin your list with your most recent employer. Provide us with their addresses, dates of employment (from/to), reason for leaving, title/nature of work and the name/title of your immediate supervisor.*

    You may upload an optional resume if you feel this will be helpful.

    References checked by: This is for company use only.

    Are you employed now?*

    YesNo

    If yes, may we inquire of your present employer?

    YesNo

    Do you have any commitments to another employer which might affect your employment with us?

    Are you subject to any restrictive covenants from prior employment such as agreements to protect confidential or proprietary information or agreements not to compete? If so, please explain:

    Personal References:*
    Provide the name, address, telephone number, business name, and years acquainted, of 3 persons not related to you who have known you for longer than 1 year.

    References checked by:
    This is for company use only.

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    CORI (Criminal Offender Record Information) Request Form

    M.G.L.c.6,  172E CORI REQUEST FORM Valley Ridge Home Care is requesting all the available criminal offender record information on the below named individual from the Criminal History Systems Board pursuant to M.G.L.c.6,  172E, which mandates that long-term care facilities complete background checks on current or prospective employees who will provide direct personal care and treatment to residents of said facility.

    CHAPTER 6,  172C CORI REQUEST FORM Valley Ridge Home Care is requesting all the available criminal offender record information on the following individual from the Criminal History Systems Board pursuant to Chapter 6 172C that mandates agencies which employ or accept as a volunteer or refer for employment any individual who will provide care, treatment, education, training, transportation, delivery of meals, instruction, counseling, supervision, recreation or other services in a home or in a community based setting for any elderly person or disabled person or who will have any direct or indirect contact with such elderly or disabled persons or access to such person’s files shall obtain all available CORI from the Criminal History Systems Board prior to employing such individual, accepting such individual as a volunteer or referring such individual for employment.

    Electronic signature Consent:Write your signature in the box by moving your mouse as a pen, using a connected stylus pen, your laptop track board, etc.

    Name*

    Maiden name or alias*

    Place of birth*

    Date of birth*

    Social security number*

    Mother's maiden name*

    Current and former address*

    Sex:*

    Height:*

    Weight:*

    Eye color:*

    State driver's license:*

    The above information was verified by reviewing the following form of government issued photographic identification
    This field filled out by name of CORI authorized employee

    Signature of CORI authorized employee
    Write your signature in the box by moving your mouse as a pen, using a connected stylus pen, your laptop track board, etc.

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    AGREEMENT: (Please read the following statement carefully)

    I certify that all information on this application and any other material provided by me is true and complete. I agree that falsified information, misrepresentations or omissions on this application, or any accompanying resume or other materials will disqualify me from consideration for employment and will be considered justification for dismissal whenever discovered.

    Unless otherwise noted, I authorize this Company or its agent to investigate and/or verify all information in this application, including contacting all persons, schools, current employer (if applicable), previous employers and other individuals or entities named herein (and those named on accompanying resume if any). I hereby authorize my former employers and other third parties named on this application to release information pertaining to my work record, habits and performances. In doing so, I hereby release them and Valley Ridge Home Care and its agents from all liability which may flow from the release of such information.

    I understand that if I am hired my employment will be on an at-will basis, for no definite term. As such, I understand that I will enjoy the right to terminate my employment at any time, and that Valley Ridge Home Care will similarly enjoy the right to terminate my employment, at any time, with or without cause. This status can only be modified by a written document setting forth such modification, signed by both me and an authorized representative of Valley Ridge Home Care. I further acknowledge that I am expected to abide by all Company rules, regulations, and policies, written or unwritten, but that such rules, regulations and policies do not create a contract between me and the Company or otherwise restrict the right of either party to terminate the employment relationship.

    Electronic signature
    Write your signature in the box by moving your mouse as a pen, using a connected stylus pen, your laptop track board, etc.

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