Online Job ApplicationStep 1 of 812%Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.Position Applying for:(Required)Please click here and select the position you are applying for using the dropdown menuAccountantAudiologistDental AssistantDental HygienistDermatologistDriver/Maintenance WorkerFamily Nurse PractitionerGeneral DentistInternistLicensed Practical NursePediatricianPhysician AssistantRegistered NurseSpeech PathologistHow did you hear about this position? Listing on Indeed.com Google Search Social Media Website Visit Current WCHC Employee OtherName of EmployeePlease describeName:(Required) First Last Address: Street Address City State / Province / Region ZIP / Postal Code Email:(Required) Enter Email Confirm Email Home Phone:Cell Phone:Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status may be required upon employment) Yes NoIf you are under 18 years of age, can you provide required proof of your eligibility to work? Yes NoHave you ever been previously employed here? Yes NoIf yes, please gives dates of your previous employment.What was your reason for leaving?Are you currently employed? Yes NoForeign Language Proficiency (Optional)Please complete the following section if you are proficient in any language other than English.Language 1Language:Please check off the box that describes your skill level with this language Read/Write/Speak Read Only Speak OnlyLanguage 2Language:Please check off the box that describes your skill level with this language Read/Write/Speak Read Only Speak OnlyLanguage 3Language:Please check off the box that describes your skill level with this language Read/Write/Speak Read Only Speak OnlyEducation, Skills and TrainingHigh SchoolHigh School – Name and Location:Grade Level Completed:Please select9th10th11th12thHigh School Diploma Yes NoGED Yes NoPost-Secondary EducationCollege:Years Completed 1 2 3 4Degree/Certification:Graduate/Professional School Name:Years Completed 1 2 3 4Did you graduate? Yes NoDescribe any other specialized training, honors, apprenticeship, skills, military service, and extra curricular activitiesWork ExperienceList most recent employer first. Include military service assignments and volunteer activities. Please account for any time gaps in your employment history, including any military service.May we contact your current employer? Yes NoMost Recent EmploymentName of Employer:Address: Street Address City State / Province / Region ZIP / Postal Code Dates Employed (include months/yr):Supervisor Name:Supervisor Phone:Responsibilities:Reason for Leaving:Did you work for this employer under a different name? Yes NoPlease give previous name:Work Experience – Employer 2Name of Employer:Address: Street Address City State / Province / Region ZIP / Postal Code Dates Employed (include months/yr):Supervisor Name:Responsibilities:Reason for Leaving:Supervisor Phone:Did you work for this employer under a different name? Yes NoPlease give previous name:Work Experience – Employer 3Name of Employer:Address: Street Address City State / Province / Region ZIP / Postal Code Dates Employed (include months/yr:Supervisor Name:Supervisor Phone:Responsibilities:Reason for Leaving:Did you work for this employer under a different name? Yes NoPlease give previous name:Work Experience – Employer 4Name of Employer:Address: Street Address City State / Province / Region ZIP / Postal Code Dates Employed (include months/yr):Supervisor Name:Reason for Leaving:Supervisor Phone:Responsibilities:Did you work for this employer under a different name? Yes NoPlease give previous name:Work Experience – Employer 5Name of Employer:Address: Street Address City State / Province / Region ZIP / Postal Code Dates Employed (include months/yr):Supervisor Name:Responsibilities:Supervisor Phone:Reason for Leaving:Did you work for this employer under a different name? Yes NoPlease give previous name:Please use the space below to include additional work experience, military service, or volunteer experienceWork AvailabilityI am available to work: Full-time Part-time Temporary Shift WorkPlease indicate the days you are available to work: Monday Tuesday Wednesday Thursday Friday SaturdayAre you on lay-off and subject to recall? Yes NoCan you travel if the job requires? Yes NoDrug Testing ConsentAny person applying for a Health Center position will be required to submit to a urine test to determine if said person is a user of any controlled substance before they are hired. If the test indicates that the applicant is a user, such person shall be disqualified. Arrangements for the taking of such test will be done through the Westchester Community Health Center. ALL TEST RESULTS WILL BE CONFIDENTALConsent I understand that I will need to submit a urine test prior to being hired at the Westchester Community Health Center.Applicant Data Record (Optional)As emplyers’/government contractors, we comply with government regulations, including affirmative action responsibilities where they apply. Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap, or any other legally protected status.Solely to help us comply with government record-keeping, reporting, and other legal requirements, we request that you please fill out our Applicant Data Record. We appreciate your cooperation.This data is for periodic government reporting and will be confidential and will have no bearing on your employment application. YOUR COOPERATION IS VOLUNTARY.Please identify where you learned about this employment opportunity with Mount Vernon Neighborhood Health Center Advertisement Online Employment Agency Relative Walk-In Friend OtherIf other, please indicate your source.Race/Ethnicity (please check all that apply): White – a person having origins in any of the original peoples of Europe, the Middle East, or North Africa Black or African American – a person having origins in any of the black racial groups of Africa Hispanic or Latino – a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race American Indian or Alaska Native – a person having origins in any of the original peoples of North and South America, including Central America, and who maintains tribal affiliation or community attachment Asian – a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Phillipine Islands, Thailand, and Vietnam Native Hawaiian or Other Pacific Islander – a person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific IslandsSex: Male Female Transgender Female Transgender Male Gender Variant/Non-Conforming Not-ListedPlease listSpecial Employment Notice to Disabled Veterans, Vietnam-Era Veterans, and Individuals with Physical or Mental HandicapsGovernment contractors are subject to 38 USC 2012 of the Vietnam Era Veterans Readjustment Act of 1974 which required that they take affirmative action to employ and advance in employment qualified disabled veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.If you are a disabled veteran or have a physical or mental handicap you are invited to volunteer this information which will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.If you wish to be identified, please indicate your status below. Handicapped Individual Diabled Veteran Vietnam-Era VeteranSupporting DocumentsPlease upload your resume(Required)Max. file size: 256 MB.You may also upload a cover letter if you wish (optional)Max. file size: 256 MB.Applicant AffirmationConsent I certify that I have read and understand this entire employment application and that the answers given herein are true and complete to the best of my knowledge.Consent I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.Consent I understand that neither this document nor any offer of employment from the employer constitute an employment contract unless a specific document to that affect is executed by the employer and employee in writing.Consent In the event of employment, I understand that false or misleading information given in amy application or interview(s) may result in discharge. I release employers and other persons named herein from all liability for any damages on account of furnishing false information.Consent I understand that I am required to abide by all rules and regulations of the employer.Please sign:Date of Signature:This application for employment shall be considered active for a period of time not exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. If you have any questions, please contact our HR Department at xxxxx.Thank you for your interest in the Mount Vernon Neighborhood Health Centers. We are an equal-opportunity employer.CAPTCHANameThis field is for validation purposes and should be left unchanged.