Job Application: Day Hab Case Manager

Job Application: Day Hab Case Manager

We consider applications for all positions without regard to age, race, color, religious creed, national origin, sex, sexual orientation, handicap/disability, or any other legally protected status pursuant to Massachusetts Fair Employment Practices Act, and other relevant federal, state and local laws. Those applicants requiring reasonable accommodation to the application and/or interview process should notify Human Resources.

Title: Day Hab Case Manager

Fields marked with an asterisk (*) must be filled out before submitting.


Last Name *
First Name *
Middle Name
Address *
City *
State *
Postal Code *
Phone Number *
Email Address *
Are you legally eligible for employment in this country? * Yes
Are you over the age of 18? * Yes


Position applied for *
How did you hear of this position? Newspaper
Internet Job Post
GROW Associates Website
Social Media
Current Employee
If you were referred by a current employee, please list their name
Have you ever been employed by GROW Associates Inc. ? * Yes
If yes, list the dates and position held.
What is your desired salary range?
Employment desired * FULL-TIME only
What date would you be able to begin work?
Do you have a valid Driver`s License? * Yes
State of issue *
List any special training or skills relevant to the position for which you are applying


High School Attended/Location *
Did you graduate or receive a GED? (If yes, specify which) *
College or Trade School Name/Location
Years Completed
Did you graduate? (If yes, list degree(s), major, minor)
Other education/training


Employer Name *
Employer Address
Phone Number
Start Date *
End Date *
Your Job Title *
Description of Duties: *
Reason for Leaving *
Employer Name
Employer Address
Phone Number
Start Date
End Date
Your Job Title
Description of Duties:
Reason for Leaving
Employer Name
Employer Address
Phone Number
Start Date
End Date
Your Job Title
Description of Duties:
Reason for Leaving
May we contact your previous employer for a reference Yes


Give the name and telephone number of three (3) professional references.
Professional Reference 1 *
Professional Reference 2 *
Professional Reference 3 *


Attach Resume
Attach Cover Letter


I certify that all information I have provided in order to apply for and secure work with GROW Associates, Inc. is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient to cancel further consideration of this application, or immediately terminate my employment whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents 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 agree that any and all previous or current employers, educational institutions, licensing or accreditation agencies or private individuals shall not be liable with regard to any information provided by them in connection with this release.

All conditional offers of employment are contingent on a satisfactory back ground check that includes and not limited to the Criminal Offender Record Information and driving record review.

If I am hired, I understand that any employment relationship with this organization is of an “at will” nature. I am free to resign at any time with or without cause and without prior notice and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer 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 Executive Director.

I also 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 federal immigration laws require me to complete an I-9 Form in this regard.

I understand that this application remains valid for 60 days. At the conclusion of this time, if I have not heard from GROW Associates, Inc. and still wish to be considered for employment, I will be required to fill out a new application.

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 liabilities.

Applicant’s Signature

By entering your full name in this box as your electronic signature, you acknowledge that you have read and understand the above applicant statement.

Full Name *