Application for Employment

Please read carefully and fill out all the fields. The questions on this application enable us to properly evaluate your ability and chance for success in the position for which you are applying. Your applications will not be processed unless all questions are answered.
This application conforms to Federal and State laws. Prima CARE, P.C. is an equal opportunity employer and does not discriminate because of color, race, sex, religion, age, national origin, disability or sexual orientation. Prima CARE, P.C. will reasonably accommodate qualified disabled applicants in the workplace.
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. Prima CARE, P.C. will conduct a background check upon an interview.
Prima CARE, P.C. will conduct a background check upon an interview.
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PERSONAL INFORMATION


PERSONAL INFORMATION

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Start with your present or last job. Give a complete history of employment experience and reasons for period unemployment during the past ten years. Begin with the most recent employment. You may include in this work history any verifiable work performed on a volunteer basis. Please complete this section in detail.


Start with your present or last job. Give a complete history of employment experience and reasons for period unemployment during the past ten years. Begin with the most recent employment. You may include in this work history any verifiable work performed on a volunteer basis. Please complete this section in detail.

Present or last job:
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Other Job
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Other Job
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EDUCATION


EDUCATION

Elementary
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High School
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College
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Trade, Business or Correspondence School
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Office Skills


Office Skills

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REFERENCES


REFERENCES

Complete names, addresses and phone numbers of three references who are not relatives or previous employers. This is needed to verify your qualifications for the position. If this section is not completed in full, a delay in processing your application for employment will result.

First Reference


First Reference

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Second Reference


Second Reference

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Third Reference


Third Reference

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Resume


Resume

I certify that the answers given by me to the foregoing questions and statements are true and correct without consequential omissions of any kind whatsoever. I agree the Prima CARE, P.C. shall not be liable in any respect if my employment is terminated because of falsity of statements, answers or omissions made by me in this questionnaire. I authorize the medical facilities companies, schools or persons named to give nay information regarding me. I herby release said medical facilities, companies, schools, and persons from all liability for any damage for issuing this information. In addition, if accepted for employment, I herby agree to abide by the rules and policies of my employer and accept the established pay period as provided in accordance with the Fair Labor Standards Act (as amended).
I understand that, upon an offer of employment, I need to conform with The Immigration Reform and Control Act of 1986. I further understand that failure to do so will prohibit me from starting employment.
I understand that employment is contingent upon successful completion of a physical examination given by a provider of the employee's choice.
I understand that if I am hired, my hiring will not be considered as creating a contractual relationship for a definitive term between me and Prima CARE, P.C. I thus understand that, unless otherwise specifically set forth in a separate written document signed by me and by an authorized representative of Prima CARE, P.C., I will be employed ‘at will’ meaning that either I or Prima CARE, P.C. may terminate my employment at any time.
Do you agree to the terms described above?

Please send your resume to ssmith@prima-care.com


Please send your resume to ssmith@prima-care.com