Application Form

The Company considers all applicants without regard to race/color, national origin, sex, age, disability, genetics, physical or mental handicap, veteran or national guard status, religion, ancestry, genetic information, sexual orientation, pregnancy, or any other category protected by federal, state or local law. Equal access to programs, services and employment is available to all persons.  Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

If you need assistance in completing this application, please let us know so that we can discuss a reasonable accommodation.

Referral Source (Please add the name the sources according on the fields provided)

Are you legally eligible for employment in the US?

Will you travel if job requires it?

Have you ever worked for us before?

Provide the dates below

Do you have any relatives employed at the Company?

Will you work overtime if required


Starting with your most recent employer, provide the following information. You may include military service and any verifiable volunteer work.

Dates Employed

Dates Employed

Dates Employed


Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying.


Starting with your most recent school attended, provide the following information.


List name and telephone number of three professional references who are not related to you, preferably direct supervisors. If not applicable, list three school or personal references who are not related to you.

Integrated Human Resources may run background checks appropriate to the position including, but not limited to, references, criminal, sexual offender, credit, driving, personality, or drug.

Massachusetts Lie Detector Law: 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 and civil liability.


I certify that all information I have provided in order to apply for and secure work with the Company is true, complete and correct.


I expressly authorize, without reservation, the Company, its representatives, employees or agents to conduct a background check and to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby release any individual, agent, and the Company and its agents, servants, and employees, directors, officers and representatives from all claims and liabilities whatever that may arise from disclosure of such information.


I understand that the Company does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law. The Company is an at-will employer. At any time and for any reason either you or the Company may terminate employment.


If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the Company reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the Company is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the Company’s Executive Director.


I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws required me to complete an I-9 Form in this regard.


I also understand that for certain positions I may be subject to a CORI check or background check and may be required to undergo drug testing.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer’s service, whenever it is discovered.



I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.