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MAS Community Health Application

Are you ready to start making a difference in your community? Take the next step to access great-paying jobs across the state of Maine. Let us help you find a job that fits your goals. Fill out the application below, and a member of our team will be in touch promptly.

Community Health Maine Application

Please provide us with a completed Application as well as a completed skills checklist within your specialty.

Step 1 of 2

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Personal Information
Our policy is to provide equal employment opportunity to all qualified people. Those applicants requiring reasonable accommodation for the application and/or interview process should notify a representative of MAS.
Today's Date*
Position you are applying for*
First Name*
Middle Name
Last Name*
Street Address (Permanent Address)*
City / Town*
State*
ZIP Code*
Phone Number*
Email Address*
Preferred Contact Method*
- Phone
- Text
- Email
- Any
Type of Employment preferred*
Please check all that apply
- Full-Time
- Part-Time
- Per Diem
- Temporary
- Seasonal
Were you referred by an MAS Employee?*
- Yes
- No
MAS Employee Name
Please provide the name of who referred you to MAS Medical Staffing.
First Last
Are you 18 years of age or older*
- Yes
- No
Do you have the legal right to work in the United States?*
- Yes
- No
Have you previouly been employed with MAS Medical Staffing?*
- Yes
- No
Educational Background
Please check levels of education you have completed.*
You may be required to provide a proof of education once hired.
- High School
- GED
- College
- Graduate School
- Other
- none
Did you graduate?*
- Yes
- No
- Still in school
Number of Years Completed*
Please list additional skills, qualifications, or experience that we should consider?
Employment History
Please list your employment history starting with your present or most current employment.
Employer Name*
Address*
Position/Title*
Name of Supervisor/Scheduler/HR Representative*
First Last
Phone*
Dates of Employment*

Please provide the start month/year to end month/year.
Why did you leave this position?*
(If Current Job) May We Contact This Employer?*
- Yes
- No
Employer Name*
Position/Title*
Name of Supervisor/Scheduler/HR Representative*
First Last
Address*
Phone*
Dates of Employment*

Please provide the start month/year to end month/year.
Why did you leave this position?*
Employer Name*
Employer Address*
Position/Title*
Name of Supervisor/Scheduler/HR Representative*
First Last
Phone*
Dates of Employment*

Please provide the start month/year to end month/year.
Why did you leave this position?*

FEDERAL LAW AGAINST DISCRIMINATION MAKES IT UNLAWFUL TO DISCRIMINATE AGAINST JOB APPLICATIONS ON THE BASIS OF AGE, SEX, RACE, CREED, NATIONAL ORIGIN OR COLOR.
Confirmation*
I certify that the information contained in this application is correct to the best of my knowledge and I understand any falsification, misrepresentation or omissions on this application is grounds for a refusal to hire, or if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give MAS Medical Staffing any and all information concerning my previous employment, education or any other information they may have, with regard to any of the subjects covered by this application and release all such parties and MAS Medical Staffing from all liability from any damage that may result from furnishing such information. I authorize MAS Medical Staffing to request and receive such information.

I acknowledge that any offer of employment, or my acceptance of an employment offer, if such is to occur, may be withdrawn, with or without cause and with or without prior notice, at any time, at the option of MAS Medical Staffing or myself.

If employed, I understand that I will be an employee “at-will” and either MAS Medical Staffing or I may terminate my employment at any time with or without notice for any reason not in violation of the law.

I agree to comply with MAS Medical Staffing rules, regulations and policies and acknowledge that these rules, regulations, and policies may be changed, interpreted or supplemented any time, and without prior notice to me.

I agree to have a post-offer, pre-employment physical examination as required for my position and understand that any offer of employment is contingent upon my passing this physical examination which relates to state and federal laws and regulations.

I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that the federal immigration laws require me to complete an I-9 Form in this regard.
- I certify that I have read, fully understand, and accept all terms of the above Applicant Statement.
I hereby authorize MAS Medical Staffing to contact current/previous employers listed above to conduct employment verification(s)/reference check(s) on my behalf as a condition for employment*
- I certify that I have read, fully understand, and accept all terms of the above Applicant Statement.
Full Name*

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