Email Us
Phone 1.877.367.3685
Donate
Home
Services
Services Overview
Bereavement Program
Differences
About
About Us
FAQ
Resources
Document Library
Related Links
Living with Dignity and Hope
Funeral Preparation
Recommended Reading
Careers
Volunteer
Contact Us
Home
Services
Services Overview
Bereavement Program
Differences
About
About Us
FAQ
Resources
Document Library
Related Links
Living with Dignity and Hope
Funeral Preparation
Recommended Reading
Careers
Volunteer
Contact Us
Careers
Apply for Employment
Name
*
First
Middle
Last
Address
City
ST
Zip
Phone
000-000-0000
Email Address
*
Type of Employment
Full Time
Part Time
Full or Part Time
Position Applied For
Rate of Pay Expected
Are you legally eligible for employmet in the USA?
Yes
No
Were you previously employed by Hope Hospice?
Yes
No
If yes, when?
Have you ever been convicted of a crime?
Yes
No
If yes, describe in full
Do you have any physical conditions which may limit your ability to perform the particular job for which you are applying without reasonable accommodation? (Do not answer unless you been informed of the physical requirements or essential job functions).
Yes
No
If yes, describe such limiting conditions and explain how you can perform a job:
Have you ever had your professional license suspended or revoked?
Yes
No
Do you have relatives that are employed here?
Yes
No
High School Education
HS Name
HS Address
HS City
HS State
HS Zip
HS What years attended
Did you graduate from HS?
Yes
No
Diploma?
Yes
No
Vocation/Technical School Education
VoTech School Name
VoTech Address
VoTech City
VoTech State
VoTech Zip
VoTech Years attended?
Did you graduate from VoTech?
Yes
No
Degree from VoTech?
Yes
No
VoTech Degree Name
College Education
College Name
College Address
College City
College State
College Zip
Did you graduate?
Yes
No
College years attended
Did you receive a degree?
Yes
No
College degree name
Licenses & Certificates
Do you have any applicable licenses or certificates?
Yes
No
If yes, please list licenses or certificates
Professional Reference 1 (excluding family members)
Reference 1 Name
Reference 1 Address
Reference 1 City
Reference 1 State
Reference 1 Zip
Reference 1 Phone #
Professional Reference 2 (excluding family members)
Reference 2 Name
Reference 2 Address
Reference 2 City
Reference 2 State
Reference 2 Zip
Reference 2 Phone #
Professional Reference 3 (excluding family members)
Reference 3 Name
Reference 3 Address
Reference 3 City
Reference 3 State
Reference 3 Zip
Reference 3 Phone #
Employment History (most recent first)
Business 1 Name
Business 1 Address
Business 1 City
Business 1 State
Business 1 Zip
Business 1 Phone
Business 1 Type of Business
Business 1 Position you held
Business 1 Start date
Business 1 End date
Business 1 Reason for leaving
Business 1 Describe the work you did
Employment History 2
Business 2 Name
Business 2 Address
Business 2 City
Business 2 State
Business 2 Zip
Business 2 Phone
Business 2 Type of Business
Business 2 Position you held
Business 2 Start Date
Business 2 End Date
Business 2 Reason for leaving
Business 2 Decribe the work you did
Employment History 3
Business 3 Name
Business 3 Address
Business 3 City
Business 3 State
Business 3 Zip
Business 3 Phone
Business 3 Type of Business
Business 3 Position you held
Business 3 Start date
Business 3 End date
Business 3 reason for leaving
Business 3 Decsribe the work you did
If there has been a time lapse between your last employment to present, descibe why and what you have been doing during that time:
Other
Next of kin (in case of emergency)
Next of Kin Phone
Do you own a car?
Yes
No
Make/Model
Driver's License #
Physician
Date of last physical exam:
Required
I have answered the above questions honestly and to the best of my knowledge. I understand and falsification of this information may be means for immediate termination.
Signature
*
Date
*
