Surgical Technology Certificate Program – REGISTER - D-H Workforce Readiness Institute

We look forward to meeting you at the event. Once you submit this form you will receive a confirmation e-mail with the date, time, location and parking information. If you have any questions or concerns in advance of the information session please reach out to us at wri@hitchcock.org .

Attendance *

I will be attending an Information Session.

I cannot attend, but would like to receive information about future training opportunities.

Which Information Session will you be attending? *

Name *

First

Last *

Last

Email *

Phone *

Address *

Address Line 2

City *

State *

Zip *

Questionnaire:

To help us better know you and further assess your qualifications for this position, please answer the following questions as accurately as possible.

1. Have you previously been employed by Dartmouth-Hitchcock at any of its locations? If yes, please indicate location and department. *

Yes

No

Location and Department *

2. Are you a current employee of Dartmouth-Hitchcock? If yes, please indicate location, department and date of hire. *

Yes

No

Location and Department *

Date of Hire *

3. Are you legally eligible for employment in the United States? *

Yes

No

4. Will you now or in the future require sponsorship for employment visa status (e.g. H-1B visa status)? *

Yes

No

5. Are you under 18 years of age? *

Yes

No

6. Have you ever been convicted in any state of any felony, sexual assault, other violent crime, assault, fraud, abuse, neglect or exploitation of any person, that has not been annulled by a court? (Note to Applicant: Convictions which have not been annulled will not necessarily bar you from employment. We will consider factors such as age when the offense occurred, the recentness of the offense, the seriousness and nature of the violation, the nature of the position applied for and any rehabilitation undergone. Failure to disclose a conviction can lead to withdrawal of the employment offer.) *

Yes

No

7. How did you hear about the program ? * 7. How did you hear about the program ?

Please upload the following documents or bring them with you to the information session:

Current resume
Cover letter that outlines why you are interested in the Pharmacy Technician Apprenticeship Program and how it aligns with your future career goals
Professional Reference Letter

Upload your files here. Multiple files accepted.

Maximum file size: 52.43MB

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Questionnaire:

Please upload the following documents or bring them with you to the information session:

Documents to Upload OR Bring to the Information Session

Contact Information