Non-employee hiring request, Faculty form

Martinos Faculty name *

Martinos Faculty email *

Name of who should be contact for correspondence in the lab (if not the PI directly). Please include MGH User ID or email address *

Do you have an email with hiring approval from Donna Crowe *

Yes
No

If no, go back to the hr.martinos.org webpage and complete Step 1.

Candidate's full name *

Candidates email address *

Is the candidate a student? *

Yes
No

Indicate current Student enrollment: *

High School
Undergraduate program
Graduate Program – Master’s Degree
Graduate Program – Medical Student
Graduate Program – MD/Phd
Graduate Program – PhD
Graduate Program – Other (include in comments section below)
Not currently enrolled in an educational program

If yes, what school? *

Requested start date (Please allow 3 WEEKS to process) *

Anticipated end date *

Position Description - 4-5 sentence description of non-employee's responsibilities, and if a student, how this internship directly correlates with the non-employee’s studies. If the non-employee has external funding to do work at MGH, please explain. ***Please do not reference a grant as the description of the job.***** *

Does the non-employee require a Visa? *

Yes
No

.

If yes, what kind of Visa? *

Are we sponsoring a J-1 Visa? *

Yes
No

If yes, and we are sponsoring a J-1 visa, please provide approved Fund# from Peter Hickey for VISA fees, and proof of language proficiency. *

Click or drag a file to this area to upload.

Fund #

Will the candidate receive a stipend? *

Yes
No

If yes, was this approved in an email by Peter Hickey? *

Yes
No

if no, go back to the hr.martinos.org webpage and complete Step 1.

If yes, please provide the approved fund # *

Do you have an email with space approved by Stacey Ladieu? *

Yes
No, remote employee

If no, go back to the hr.martinos.org webpage and complete Step 1.

Is your candidtate going to be working off-campus remotely but have plans to come to MGH on occasion? *

Yes
No

If yes, how many hours per week? *

Indicate onsite functional area for seating *

Education
Research
Administrative
Other

Indicate seat/office location at Martinos, use TBD if exact location has not yet been decided on. Also include MGH Main Campus and outside locations (days/hours per location). Be specific. *

Is onsite work: *

Full time
Part time

If part-time, how many hours per week

Provide the plan to provide designated eating areas - - It is required that individuals be provided with a safe place to eat, unmasked at least 6 feet away from other workers. *

Criticality of On-Site work - - Please describe the reasons why this work cannot be performed virtually. *

Attestation for exemption to on-site work - - I confirm that the information provided in this exemption petition is accurate and complete, that I understand and feel comfortable that our on-site worker will comply with all Mass General Brigham and facility-specific policies. *

Yes

Will this person be working with radioactive materials?

Yes
No

Will your student work with biological materials? *

Yes
No

If your student will work with biological materials, you must attest to ALL of the following, but checking ALL boxes.

I attest that my student is enrolled in high school and will not work with biological materials higher than BL2
I attest that my student is enrolled in an undergraduate program and will only work with biological materials higher than BL2 under direct supervision
I attest that my student is enrolled in graduate program and will only work with biological materials higher than BL2 under direct supervision
I attest that my student is enrolled in a PhD program. PhD students are permitted to work with biological materials higher than BL2

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Human Resources