Online Job Application

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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)

How did you hear about this position?

Listing on Indeed.com

Google Search

Social Media

Website Visit

Current WCHC Employee

Other

Name of Employee

Please describe

Name:(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

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes

Have you ever been previously employed here?

Yes

If yes, please gives dates of your previous employment.

What was your reason for leaving?

Are you currently employed?

Yes

Foreign Language Proficiency (Optional)

Please complete the following section if you are proficient in any language other than English.

Language 1

Language:

Please check off the box that describes your skill level with this language

Read/Write/Speak

Read Only

Speak Only

Language 2

Language:

Please check off the box that describes your skill level with this language

Read/Write/Speak

Read Only

Speak Only

Language 3

Language:

Please check off the box that describes your skill level with this language

Read/Write/Speak

Read Only

Speak Only

Education, Skills and Training

High School

High School – Name and Location:

Grade Level Completed:

High School Diploma

Yes

GED

Yes

Post-Secondary Education

College:

Years Completed

Degree/Certification:

Graduate/Professional School Name:

Years Completed

Did you graduate?

Yes

Describe any other specialized training, honors, apprenticeship, skills, military service, and extra curricular activities

Work Experience

List 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

Most Recent Employment

Name 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

Please give previous name:

Work Experience – Employer 2

Name 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

Please give previous name:

Work Experience – Employer 3

Name 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

Please give previous name:

Work Experience – Employer 4

Name 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

Please give previous name:

Work Experience – Employer 5

Name 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

Please give previous name:

Please use the space below to include additional work experience, military service, or volunteer experience

Work Availability

I am available to work:

Full-time

Part-time

Temporary

Shift Work

Please indicate the days you are available to work:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Are you on lay-off and subject to recall?

Yes

Can you travel if the job requires?

Yes

Drug Testing Consent

Any 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 CONFIDENTAL

Consent

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

Online

Employment Agency

Relative

Walk-In

Friend

Other

If 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 Islands

Sex:

Male

Female

Transgender Female

Transgender Male

Gender Variant/Non-Conforming

Not-Listed

Please list

Special Employment Notice to Disabled Veterans, Vietnam-Era Veterans, and Individuals with Physical or Mental Handicaps

Government 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 Veteran

Supporting Documents

Please 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 Affirmation

Consent

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.

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Foreign Language Proficiency (Optional)

Language 1

Language 2

Language 3

Education, Skills and Training

High School

Post-Secondary Education

Work Experience

Most Recent Employment

Work Experience – Employer 2

Work Experience – Employer 3

Work Experience – Employer 4

Work Experience – Employer 5

Work Availability

Drug Testing Consent

Applicant Data Record (Optional)

Special Employment Notice to Disabled Veterans, Vietnam-Era Veterans, and Individuals with Physical or Mental Handicaps

Supporting Documents

Applicant Affirmation

Navigation

Contact Us

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Foreign Language Proficiency (Optional)

Language 1

Language 2

Language 3

Education, Skills and Training

High School

Post-Secondary Education

Work Experience

Most Recent Employment

Work Experience – Employer 2

Work Experience – Employer 3

Work Experience – Employer 4

Work Experience – Employer 5

Work Availability

Drug Testing Consent

Applicant Data Record (Optional)

Special Employment Notice to Disabled Veterans, Vietnam-Era Veterans, and Individuals with Physical or Mental Handicaps

Supporting Documents

Applicant Affirmation

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