Application for Employment

Fellow Health Partners, Inc. Is An Equal Opportunity Employer

All applicants for employment are required to complete and submit this Employment Application.
Fellow Health Partners does not discriminate on the basis of sex, age, color, race, religion, marital status, national origin, ancestry, sexual orientation, physical & mental disability, medical condition, genetic information, veteran status, or any other basis protected by federal, state or local law.

APPLICANT INFORMATION

Date:
Legal Name:
Last*

First*

Middle Initial

Complete Permanent Address:
Street 1*

Street 2 (apt #, building #, etc.)

City*

County

Zip*

Preferred Phone Number*

Alternate Telephone

Are you currently registered with the New York Youth Jobs Program (WOTC)?*

YesNo

If hired, are you willing to undergo a background check, in accordance with local law/regulations?*

YesNo

Are you authorized to work in the following country: United States?*

YesNo

Have you worked for/or applied for a position at the company before?*

YesNo

Position*

How did you hear about us? (check all that apply)

FacebookLinkedInIndeed

Referred by
Other

FULL TIME POSITION APPLYING FOR

Job location (check all that apply)*

Great River, NYRochelle Park, NJ

Desired salary
$
Date available to start (check all that apply)*

2-4 weeks1-3 months4-12 months

Do you meet all of the required education/experience within this job description?*

YesNo