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Hartford HealthCare Corporation Application for Employment

Please complete all spaces on this application even if a resume is submitted, but do not include extraneous or non-responsive information.  Hartford HealthCare Corporation and its affiliates/subsidiaries are Affirmative Action/Equal Opportunity employers, and do not discriminate on the basis of race, sex, color, creed, national origin, ancestry, sexual orientation, age, marital status, religion, veteran status or disability.  All information requested on this application has been determined essential to the processing of applications for employment.

To submit your application please complete the form below. Fields marked with a red asterisk * are required. When you have finished click Submit at the bottom of this form.

Click the LinkedIn link to use your LinkedIn profile to pre-fill this application form.
Click the Upload Resume to use your resume to pre-fill this application form.
Click the Universal Profile link to use your Universal Profile to pre-fill this application form.

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Email Registration

Your email address will be used as your login name allowing you to return to our website update your profile. If you do not have an email address, you can obtain a free account at Yahoo or Hotmail. Please make sure that the syntax of your email address is in the following form: username@ispname.com

Please create your password.
Passwords must be at least eight (8) characters.

Personal Information

                       (Telephone Format: 860-111-2222)

                       (Telephone Format: 860-111-2222)

List other names under which your records may be found.

Additional Information

Are you currently employed by Hartford HealthCare Corporation?

Have you ever been employed by any company in Hartford HealthCare Corporation?
If so, provide details under Employment History section below.

What is the highest level of Education completed?

Education - Provide Education detail information below:

+ Add Another Education    

List scholastic honors, specialized training, apprenticeship, and extra-curricular activities that may be helpful in considering your application:

Certificates/Licenses - Provide Professional Licensure details below:


+ Add Another Certificates And Licenses    

Do you have previous work experience?

Employment History - Provide your last four employment experiences. Account for any time during this period that you were unemployed.:

             (If Employer is one of the Hartford Healthcare companies, enter your Employee ID)

          (If still currently employed, select today's date in Date To drop-down and choose Still Employed in Reason for Leaving drop-down)

Responsibilities and Duties

+ Add Another Work History    

How did you hear about us?

References - Provide 3 (three) professional references. DO NOT list relatives.:

Additional Information

TIP:  Use the CTRL key to select more than one item in a list


Please answer the following questions:

Are you legally authorized to work in the United States?

Do you have any relatives employed within the company to which you are applying?
(This information is used only to determine if there are hiring conflicts)
If yes, name and relationship:

Have you ever been disciplined, terminated, asked to resign from a job or left because of negligence, neglect, abuse (i.e, physical/sexual) or any violation of any employer's policy and procedure?
If yes, please describe (Past violation will not necessarily disqualify an applicant from employment):

Are you currently or have you ever been excluded from participation in State or Federal Health Care Programs (e.g., Medicaid, Medicare) in any previous Employment?
Past exclusion will not necessarily disqualify an applicant from employment)
If yes, please give information regarding the situation:

Resume Attachment

Your resume can be uploaded in any of the following formats: DOC, DOCX, RTF, PDF, TXT, HTML. To complete the attachment, be sure to select the SUBMIT button at the bottom of the screen.

Add Resume & Attachments

Cover Letter
You can use the text area for a cover letter and any supplementary information you would like to provide about your career goals, availability, best times to contact you, etc.



I certify that the information on this application and/or on my resume is true and correct. I understand that Hartford HealthCare Corporation may verify pertinent information which I have stated and I authorize them to do so and to obtain a copy of my personnel file from former employers. Should Hartford HealthCare Corporation find that I have ever falsified any information or omitted my material information I understand my employment could be terminated or that my application for employment could be disqualified.

I understand that a pre-employment drug test is required to be completed within 48 hours of job offer, or as agreed. I agree to fully cooperate with the required procedure and realize that failure to do so will disqualify me from further consideration for employment. I also realize that if the drug test reveals usage of prohibited substances, I may not be employed by the hospital or its affiliates. If employed I recognize that the hospital or its affiliates have the right to require substance abuse test whenever my actions, in the opinion of supervisors, reflect a reasonable suspicion of illegal or improper substance abuse. Once offered a position, which shall be on a contingent basis initially, I understand satisfactory completion of a pre-placement physical assessment is required prior to a final offer of employment and starting actual work.  I understand that as a condition of employment, all Hartford HealthCare staff members must receive an annual influenza vaccination unless they have a verified medical or religious exemption.

I understand that this application and/or any resultant employment at Hartford HealthCare does not imply or indicate any intent of establishing any contractual relationship. I further understand that my employment is at will and can be terminated by me or Hartford HealthCare at any time, for any reason. Also, I understand that this application is not an offer of employment.

I further understand that all application and/or resumes submitted for employment consideration become property of Hartford HealthCare Corporation.

My typed name below shall have the same force and effect as my written signature.


Voluntary Equal Opportunity Questionnaire

As an equal opportunity employer, we hire without consideration to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.
Criminal History Verification
“Conviction” for this application means a final judgment or verdict of guilty, a plea of guilty, or a plea of nolo contendere, in any state or federal court, regardless of whether an appeal is pending or could be taken.   
“Conviction” does not include a final judgment or verdict that has been expunged by pardon, reversed, set aside or otherwise rendered invalid. Further, you are not required to disclose any arrest(s), criminal charge (s) or conviction (s) the record (s) of which have been erased under law. Such records can include records of a finding of delinquency or that a child was a member of a family with service needs, adjudication of youthful offender status, criminal charges dismissed or nolled, or charges for which a person is found not guilty or a conviction later resulting in an absolute pardon. 
 Further, any person whose criminal records have been erased is deemed under law never to have been arrested with respect to such erased proceedings and may so swear under oath. 
  A history of criminal conviction (s) will not necessarily bar consideration of employment. Factors such as the time, seriousness and nature of the offense, as well as rehabilitation, will be taken into account.  
 Should you have any questions about answering questions on this application, or your rights concerning erased records, please inquire of a Human Resources Consultant 

Have you ever been convicted of a crime, including misdemeanor and felony offense(s)?

If No, please enter N/A under Explanation.

Are there any criminal charges currently pending against you?

If No, please enter N/A under Explanation.


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