Clearview Cancer Institute - Job Application

Quick Links:

Events & Groups:

Become a Fan

Join Us On Facebook.

Follow us on Twitter.

Follow us on Twitter.

Job Application

Oncology Specialties, P.C. is an Equal Opportunity Employer.

We do not unlawfully discriminate against any applicant on the basis of race, color, religion, sex, national origin, age, sexual orientation, disability or any other category protected by federal, state or local law.

Upload Your Resumé (optional):

If you have a resumé, you may upload a Microsoft Word document or a PDF file. Just click the browse button and select your resumé file on your hard drive.

If you choose to upload your resumé, please note that you must continue and fill out the form fields below. Resumé files uploaded without application forms will be discarded.

Required Fields are bold

General Information:

Today's Date: July 31, 2010
Full Legal Name:
Home Phone: (Include Area Code)
Cell Phone: (Include Area Code)
Email Address:
Street Address:
City:
State:
Zip: (5 digit zip)
Position Applied For:
Salary Desired:
Social Security Number:
Date you can start:
Are You Employed Now:
If So, May We Contact Your Present Employer:
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Yes No

Education:

Highest Grade Completed:
Did You Graduate?
Yes No
High School Attended:
Number of years of post high school education?

School 1:

Name of Institution:
Address
1. School Address:
2. School City:
3. School State:
4. School Zip: (5 digit zip)
Degree:
Major:
Dates Attended:

School 2:

Name of Institution:
Address
1. School Address:
2. School City:
3. School State:
4. School Zip: (5 digit zip)
Degree:
Major:
Dates Attended:

School 3:

Name of Institution:
1. School Address:
2. School City:
3. School State:
4. School Zip: (5 digit zip)
Degree:
Major:
Dates Attended:

If you plan to complete an educational program in the future, then indicate the degree or program

Additional Degree 1

Degree:
Completion Date:

Additional Degree 2

Degree:
Completion Date:

Work Experience

Start with your most recent work experience. Describe your knowledge, skills, and abilities that demonstrate your qualifications for the position for which you are applying.

Employer 1:

Job Title:
Dates of Employment:
Employer Name:
Phone: (Include Area Code: e.g. 123-456-7890)
Employer's Address:
1. Street
2. City:
3. State:
4. Zip: (5 digit zip)
Duties:

Employer 2:

Job Title:
Dates of Employment:
Employer Name:
Phone: (Include Area Code: e.g. 123-456-7890)
Employer's Address
1. Street:
2. City:
3. State:
4. Zip: (5 digit zip)
Duties:

Employer 3:

Job Title:
Dates of Employment:
Employer Name:
Phone: (Include Area Code: e.g. 123-456-7890)
Employer's Address
1. Street:
2. City:
3. State:
4. Zip: (5 digit zip)
Duties:

Specialized Job Skills:

Use the following space to provide any additional information that you think would be helpful in our evaluation of your job application. This can include specialized training, workshops, accreditations, special achievements or valuable skills:

Professional Licenses and/or Certifications

License / Certification 1

Type:
License Number:
Granted By:

License / Certification 2

Type:
License Number:
Granted By:

License / Certification 3

Type:
License Number:
Granted By:

References:

List three references that are not related to you that we may contact

Reference 1:

Full Name:
Address:
1. Street:
2. City:
3. State:
4. Zip: (5 digit zip)
Phone: (Include Area Code: e.g. 123-456-7890)
Years Acquainted:

Reference 2:

Full Name:
Address:
1. Street:
2. City:
3. State:
4. Zip: (5 digit zip)
Phone: (Include Area Code: e.g. 123-456-7890)
Years Acquainted:

Reference 3:

Full Name:
Address
1. Street:
2. City:
3. State:
4. Zip: (5 digit zip)
Phone: (Include Area Code: e.g. 123-456-7890)
Years Acquainted:

U.S. Military:

U.S. Military Experience?
Yes No
Rank:

Prior Convictions:

Have you ever been convicted of any violation of law?
Yes No
Have you ever been convicted of a Misdemeanor?
Yes No
Have you ever been convicted of a Felony?
Yes No
If you answered yes to any of the above, please explain:

Have you submitted an application to us before?
Yes No
If yes, give date/position:

Have you ever worked for us before?
Yes No
If yes, give date(s), position(s) held, and reason(s) for leaving:

Do you have a family member working with Oncology Specialties, P.C.?
Yes No
If yes, give name, department and location:

In Case of Emergency Notify:

Job Application Certification:

I hereby declare that the information provided by me in the Application for Employment (and in any accompanying resumé) is true, correct and complete to the best of my knowledge. I authorize Oncology Specialties, P.C. to investigate my past and present employment, education and activities and verify all data provided by me on the application, on related papers and in interviews. I authorize all individuals, schools and/or firms named herein (except my current employer, if so noted) to provide any information requested about me. I release from all liability any persons, companies, corporations or educational institutions supplying such information. I understand that any false statement or material omission on this application, or on any supporting documents, shall be grounds for non-hire or discharge, regardless of when discovered by Oncology Specialties, P.C.

I understand that this employment application, or the granting of an interview, does not represent a contract of employment or a promise of future benefits by Oncology Specialties, P.C. I understand that there is no guarantee that Oncology Specialties, P.C. will be able to place me in a position. lf I am hired by Oncology Specialties, P.C., I understand that my status will be that of an employee-at-will, meaning that lwill have no contractual right, express or implied to remain in Oncology Specialties, P-C.'s employment. I further understand that, if I am hired, my employment can be terminated, with or without cause and with or without notice at any time, at the option of Oncology Specialties, P.C. or me. I also understand that no representative of Oncology Specialties, P.C. has the authority to enter into any oral agreement for employment for a specified period of time or to make an oral agreement contrary to the foregoing.

I understand that if I am offered employment at Oncology Specialties, P.C., I will be required to provide evidence of my identity and authorization for employment in the United States.

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.

I understand and accept these terms: