• Application for Employment

    This agency does not discriminate on the basis of race, color, national origin, HIV status, gender, gender identity, disability, marital status, religion, sexualorientation, genetic information, political beliefs and where age or sex is a bonafide occupational qualification as allowed by the Civil Rights Act of 1964.
  • Nashoba Associated Boards of Health
    30 Central Ave.
    Ayer, MA 014323

    Environmental Health

    Public Health


    Phone (978) 772-3335 | Fax (978) 772-4947


    Website: www.nashoba.org

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  • Professional Licenses or Certifications:

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  • Educational Background

  • Employment History

    COMPLETE ALL INFORMATION IN FULL. A resume may be included as a supplement to written work history. Begin with your most recent employment, including any present employment. Your present employer will not be contacted without your permission. You may include any verifiable work performed on a volunteer basis. Any gaps in employment should be briefly explained. You may use a separate piece of paper to list additional employers. Please answer why you left these positions.
  • Job #1

  • Job #2

  • Job #3

  • Reference #1

    List 2 people not related to you who can provide work references if requested
  • Reference #2

  • Reference #3

  • License and Certification Information

    Lis tall applicable licenses or certifications that you may have and their expiration dates.
  • RELEASE AND CERTIFICATION

    PLEASE READ CAREFULLY BEFORE SIGNING
  • I understand that the foregoing information on the employment application will be verified in order to expedite my application for employment with Nashoba Associated Boards of Health, herein identified as NABH. I hereby authorize NABH to conduct a full investigation into my background. I authorize NABH to obtain my previous work records, employment records, school records, obtain character and professional references and any other information it deems necessary in relation for consideration of this position. Further, I grant authority to the keeper of these records to release said records to NABH for the purpose of making its hiring decision. I agree that NABH shall not be liable in any respect if a job offer is not extended, is withdrawn, or my employment is terminated because of false statement, omissions or answers made by me on this application. I agree that my previous employers shall not be liable with regard to any information provided by them in connection with this release.

     

    In compliance with the Immigration and Reform and Control Act of 1986, I understand that I will be required to provide approved documentation that verifies my right to work in the United States on my first day of employment. NABH uses the E-Verify system for verification. I understand that all results from C.O.R.I, pre-employment physical examination, drug screening and licensing boards must be satisfactory before employment, if offered, would begin. Unsatisfactory results would result in the withdrawal of any employment offer made or termination if already employed.

     

    I understand that unless I attain permanent status pursuant to MGL Chapter 31 or am subject to the terms of a collective bargaining agreement (after six months of
    employment), my employment will be at-will, which means that both the Nashoba
    Associated Boards of Health and I are free to terminate the employment relationship at any time, for any reason or for no reason at all, with or without notice.

     

    I certify under the pains and penalty of perjury that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing, which, if disclosed, would affect this application unfavorably. I understand that any false statements, omissions or answers made by me on this application can result in my immediate termination.

     

    I hereby acknowledge that I have read in full and understand the above statements and conditions of employment. I understand that this application is only current for six months.

     

  • Clear
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  • “It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.” MGL Ch.149, Section 19B

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