Online Employment Form

Partners HealthCare System, Inc., Martha’s Vineyard Hospital and Windemere Nursing and Rehabilitation Center are equal opportunity/affirmative action employers.

Personal Information

1. Last Name:(*)
2. First Name:(*)
3. Middle Name:
5. Mailing Address:(*)
6. City:(*)
7. State:(*) NONE ALASKA (AK) AMERICAN SAMOA (AS) ARIZONA (AZ) ARKANSAS (AR) CALIFORNIA (CA) COLORADO (CO) CONNECTICUT (CT) DELAWARE (DE) DISTRICT OF COLUMBIA (DC) FEDERATED STATES OF MICRONESIA (FM) FLORIDA (FL) GEORGIA (GA) GUAM (GU) HAWAII (HI) IDAHO (ID) ILLINOIS (IL) INDIANA (IN) IOWA (IA) KANSAS (KS) KENTUCKY (KY) LOUISIANA (LA) MAINE (ME) MARSHALL ISLANDS (MH) MARYLAND (MD) MASSACHUSETTS (MA) MICHIGAN (MI) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MONTANA (MT) NEBRASKA (NE) NEVADA (NV) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTHERN MARIANA ISLANDS (MP) OHIO (OH) OKLAHOMA (OK) OREGON (OR) PALAU (PW) PENNSYLVANIA (PA) PUERTO RICO (PR) RHODE ISLAND (RI) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) TENNESSEE (TN) TEXAS (TX) UTAH (UT) VERMONT (VT) VIRGIN ISLANDS (VI) VIRGINIA (VA) WASHINGTON (WA) WEST VIRGINIA (WV) WISCONSIN (WI) WYOMING (WY)
8. Zip Code:(*)
10. Physical Address:
11. City:
12. State: NONE ALASKA (AK) AMERICAN SAMOA (AS) ARIZONA (AZ) ARKANSAS (AR) CALIFORNIA (CA) COLORADO (CO) CONNECTICUT (CT) DELAWARE (DE) DISTRICT OF COLUMBIA (DC) FEDERATED STATES OF MICRONESIA (FM) FLORIDA (FL) GEORGIA (GA) GUAM (GU) HAWAII (HI) IDAHO (ID) ILLINOIS (IL) INDIANA (IN) IOWA (IA) KANSAS (KS) KENTUCKY (KY) LOUISIANA (LA) MAINE (ME) MARSHALL ISLANDS (MH) MARYLAND (MD) MASSACHUSETTS (MA) MICHIGAN (MI) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MONTANA (MT) NEBRASKA (NE) NEVADA (NV) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTHERN MARIANA ISLANDS (MP) OHIO (OH) OKLAHOMA (OK) OREGON (OR) PALAU (PW) PENNSYLVANIA (PA) PUERTO RICO (PR) RHODE ISLAND (RI) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) TENNESSEE (TN) TEXAS (TX) UTAH (UT) VERMONT (VT) VIRGIN ISLANDS (VI) VIRGINIA (VA) WASHINGTON (WA) WEST VIRGINIA (WV) WISCONSIN (WI) WYOMING (WY)
13. Zip Code:
14. Any Previous Names?(*)
15. Yes No
16. Email Address:(*)(valid email required)
17. Best time to contact you:
18. If yes, identify all other names including maiden name:(*)
19. Contact Telephone :(*)
20. Date available for work:
21. Home Telephone :(*)
23. Job Applying for:(*)
24. Job Requisition Number:(*)
25. Salary Desired:
27. how did you hear about this position?
28. How did you obtain this application?
29. Relatives or friends employed in this facility?
30. Yes No
32. Name:
33. Department:
34. Relationship:
36. Have you ever been employed by this facility?(*)
37. Yes No
39. If yes, when?
41. Are you 18 years of age or older?(*)
42. Yes No
44. Are you legally authorized to work in the US?(*)
45. Yes No
46. Would you consider working:
47. Weekends & Holidays
48. Yes No
49. Rotating Shifts
50. Yes No
51. On Call
52. Yes No
53. Any Shift
54. Yes No
55. Shift Preference
56. Days Evenings Nights
58. Are you Applying for:
59. Full-time Part-time Per diem Temporary Regular
60. Social Security #:
61. Have you ever been convicted or pled guilty to a crime(excluding misdemeanor traffic violations)?
62. Yes No
63. If yes, explain:
64. if your answer is "yes", you will not automatically be disqualified from employment consideration.except as required by law.
65. Do you have email?
66. Yes No
67. Job Applying for:
68. Job Requisition Number:
69. Salary Desired:
70. Job Applying for:
71. Job Requisition Number:
72. Salary Desired:

 

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