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Application for Employment
Equal Opportunity Employment
HOSPICE ~ HOME HEALTH ~ PRIVATE DUTY
Your stay-at-home specialists
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Date: |
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| Name: (Last, First, Middle): |
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Social Security Number: |
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| Street Address: |
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City, State, ZIP: |
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| Home Phone: |
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Cell Phone: |
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| Are you at least 18 Years of Age? |
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Email Address: |
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| Position Applying for: |
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Office Location: |
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| Date Available to Work: |
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Presently Employed? |
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| Salary Required: |
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Are You Available to Work: |
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| Where did you hear about the position? |
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Ever been convicted of a felony? |
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| Skills and Qualifications: |
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List any career objectives you may have: |
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EDUCATION (Please begin with last school attended. Put School Name, Address and Phone in Name) |
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School Name |
Years Completed |
Area of Study |
Did You Graduate? |
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EMPLOYMENT HISTORY (Begin with last position first. At least 7 years of work history must be provided.) Please list Name, Address of Employer in 'Name' field. |
| Name |
Phone |
Supervisor |
Dates Worked |
Position Held |
Pay Rate |
Reason for Leaving |
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| May we contact your present employer? |
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REFERENCES (Give name, address and telephone number of three (3) references who are not related to you and are not previous employers.) |
| Reference 1: |
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| Reference 2: |
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| Reference 3: |
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| Upload Resume (optional): |
Choose the file on your computer |
I understand and agree that any material misrepresentation or deliberate omission of a fact in my application may result in refusal of, or if employed, immediate termination from employment. Although management makes every effort to accommodate individual preference, business needs may at times make the following condition mandatory: overtime, shift work, rotating work schedule, or work schedule other than Monday through Friday. I understand and accept these conditions of my continuing employment. It is my understanding that Ross Health Care will make a thorough investigation of my entire work history and may verify all data given in my application for employment related papers, or oral interview. I authorize such investigation and the giving and receiving of any information requested by Ross Health Care and I release from liability any person giving or receiving such information. I agree that my employment is at will and may be terminated by Ross Health Care or myself at any time with or without notice or cause and without liability for wages or salary except such as may have been earned at the date of such termination. I further understand that this is an application for employment and that no employment contract is being offered, nor will any result from my employment with Ross Health Care. I understand that if I am employed, such employment is for no definite period of time and that Ross Health Care can change wages, benefits and conditions at any time. I acknowledge that any oral representation or written statements which may have been made to me to the contrary of this paragraph are expressly disavowed and may not be relied upon.
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Signature: (Typing your name will signify you have read and agree to the above conditions of employment with Ross Health Care.) |
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It is the policy of Ross Health Care, to comply with all applicable State and Federal laws prohibiting discrimination in employment based on race, color, sex, religion, national origin, disability, or other protected classifications.
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