Application for Employment - Relief

The relief position is 'on call, and on an as needed basis'. Interviews, and any subsequent shifts offered will be subject to agency availability.

All shifts will be provided via text messages or email.


* required field
APPLICANT INFORMATION
 

ADDITIONAL INFORMATION
The relief position is 'on call, and on an as needed basis'. Interviews, and any subsequent shifts offered will be subject to agency availability.
Please indicate any positions you may be interested in working with
Prospect Meadow Farm/Job Coach
Fit Together (Gym and Fitness Center)
Vocational Services/Job Coach
Substance Abuse (SA)
Homeless (SH)
Mental Health Recovery (MHRS)
Developmentally Disabled (DBIS)
Office
We have relief opportunities in the following areas - please indicate any location in which you'd like to work. Divisions available in each area will be listed next to the town name.
Amherst (MHRS/DBIS/SH)
Athol/Orange (MHRS/SA)
Belchertown (DBIS)
Chicopee (DBIS)
Easthampton (MHRS/DBIS)
Florence (DBIS/SH)
Greenfield (MHRS/DBIS/SH/SA)
Hadley (DBIS)
Haydenville (DBIS)
Holyoke (DBIS)
Longmeadow (DBIS)
Northhampton (DBIS/SH)
Pittsfield (DBIS/Vocational Services)
Turners Falls (DBIS)
Springfield (DBIS)
Ludlow (DBIS)
W. Springfield (DBIS)
Williamsburg (DBIS)
Hatfield (Prospect Meadow Farm/MHRS)
Please indicate if you have any of the following certificates
Med. Cert.
CPR
1st Aid
ANV
Other
Valid Driver's License?
 Yes  No
Please indicate the highest level of education you have completed
In what field is your highest degree?
Do you hold a professional license?
 Yes  No
Expiration Date
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.
Position Applied For:
How did you learn about us?
Have you ever been an employee of ServiceNet, Valley Programs, FHCMHC, etc.
 Yes  No
If yes, Date:
Have you ever filed an application with us before?
 Yes  No
If yes, Date: Application before?
Are you currently employed?
 Yes  No
May we contact your present employer?
 Yes  No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.)
 Yes  No
On what date would you be available for work?
Are you currently on "Lay-off" status and subject to recall?
 Yes  No
Would you be able to travel, if a job required it?
 Yes  No
Are you age 18 or older?
 Yes  No
Please provide your cell phone provider

References
First Reference Name
First Reference Relationship
First Reference Company Name
First Reference Phone
First Reference Email
Dates of Employment
Second Reference Name
Second Reference Relationship
Second Reference Company
Second Reference Phone
Second Reference Email
Dates of Employment
Third Reference Name
Third Reference Relationship
Third Reference Company
Third Reference Phone
Third Reference Email
Dates of Employment

Education
High School
Name of School - City, State, Course of Study, Years Completed, Diploma Degree
Undergraduate College
Name of School - City, State, Course of Study, Years Completed, Diploma Degree
Graudate Professional
Name of School - City, State, Course of Study, Years Completed, Diploma Degree
Other
Name of School - City, State, Course of Study, Years Completed, Diploma Degree
Additional Information
Indicate any foreign languages you can speak, read, and/or write. (Please label each Fluent, Good, or Fair.)
Describe any specialized training, apprenticeship, skills, and extra-curricular activities.
Describe any job-related training received in the United States military.
List professional, trade, business, or civic activities and offices held. (You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.)
Other qualifications. Summarize special job-related skills acquired from employment or other experience.
State any additional information you feel may be helpful to us in considering your application.



Thank you for your interest!
 
 
Northampton, Massachusetts 01060
1-413-387-1108
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