Employment Application

Applicant Information

First
Last
City
State/Province
Zip/Postal
Country

Availability

Travel Requirements

Education

Employment (please list most current first)

City
State/Province
Zip/Postal
Country

Employment (continued)

City
State/Province
Zip/Postal
Country

Employment (continued)

City
State/Province
Zip/Postal
Country

Employment (continued)

City
State/Province
Zip/Postal
Country

Employment Agreement

Culbert Healthcare Solutions, Inc. respects the position of any other company with regard to their employment and/or non-compete agreement. In addition, we honor all employment and/or non-compete agreements that any applicant may be subject to. As a condition of employment with Culbert Healthcare Solutions we will require that each applicant produce a copy of any such employment and/or or non-compete agreement under which a candidate may be subject to the terms and conditions of.
I certify that the information provided by me in this application, my attached resume, or any supporting documents provided orally is true and complete, and I understand that any misrepresentation, false statement and/or withholding of information will result in the rejection of this application or my discharge if discovered after employment begins. I authorize Culbert Healthcare Solutions, Inc. to make inquiries regarding my work, educational background and character from any of my references, prior employers and educational institutions that I attended. I hereby release Culbert Healthcare Solutions, Inc. from any liability with respect to such inquiries. I further release all such employers and educational institutions (and individuals acting on their behalf) from any liability arising from their response to such inquiries in connection with this application for employment.

It is the policy of Culbert Healthcare Solutions, Inc. to hire its employees on an at-will basis pursuant to written offer letters or hire. It is also the policy of Culbert Healthcare Solutions, Inc. to hire employees upon completion of the interview process by providing the applicant a written offer letter to hire. Until such offer letter is issued, the applicant process is not complete and no written or oral comments by interviewers or others at Culbert Healthcare Solutions, Inc. may be considered to be an offer or promise of employment. No oral representation by any Culbert Healthcare Solutions, Inc. employee may change this Policy.

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.
Culbert Healthcare Solutions, Inc. is committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis, including but not limited to race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, handicap or disability or veteran status.

Professional References

Please list at least three business references that are familiar with the quality of your work and have known you for at least one year (i.e., supervisor, customer, and peer). Please include at least two current or most recent managers or supervisors. Please note Culbert will start contacting these references within 24 hours.
Please note Culbert will start checking references within 24 hours of receiving them.

Reference #1 – Current manager/supervisor

Reference #2 – Previous manager/supervisor

Reference #3 – Previous manager/supervisor

Reference #4 – Previous manager/supervisor