Job Application

Personal Details

First Name

Last Name

Position Applied for

Street Address

City

State

Zip Code

Phone Number

Phone

Email Address

Eligibility to Work

Are you a United States citizen?

Yes

Are you 18 years of age or older?

Yes

Do you have a valid drivers license?

Yes

Have you ever been felony?

Yes

Have you ever been employed by Caritas?

Yes

Do you have an ongoing obligation or commitment to another employer, business or activity which might affect your duties of employment?

Yes

Will you work overtime if asked?

Yes

Are you willing to work evening shifts?

Yes

What type of employment are you looking for?

Full Time

Part Time

Please list all legal names you have had other than the name used on this application:

Please specify any hours, shifts or days you will not work:

Please provide names of any relatives or friends who currently work at Caritas Hospice Care:

Previous Employment

Do you have a current resume to upload?

Yes

Resume Upload

Drop your files here

Education History

What is your highest education?

Other Training or Education Details

CPR Active?

Do you have any currently held licensures or certifications that would be applicable for the job applied for?

(Registered Nurse, Social Worker, Certified Nursing Assistant, etc)

Military Service

Are you a veteran of the US Military Services?

Yes

References

List three persons not related to you whom you have known for at least one year

Please include their name, phone number, relationship and years known

Reference 1

Reference 2

Reference 3

Please list any other information or remarks that you wish to have considered as a part of your application for employment:

NOTICE TO APPLICANTS:

Caritas Hospice Care complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions concerning your ability to perform job related functions. If you are given a conditional offer of employment, you will be required to undergo medical examination which includes a test for illicit drugs. All medical information will be kept confidential in a separate file. Caritas Hospice Care is an Equal Opportunity Employer. We adhere to a policy of making employment decisions without regard to the race, color, age, sex, religion, national origin, disability, marital status, citizenship, veteran status, sexual orientation, gender identity, or other protected group status of any qualified individual.

APPLICANTS ACKNOWLEDGEMENT --- PLEASE READ CAREFULLY BEFORE SIGNING

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give Caritas Hospice Care and its agents and representatives permission to contact schools, previous employers, references, government agencies and other, and hereby release Caritas Hospice Care and its employees and agents, as well as those persons

providing information, from any liability because of such contact or information provided.

I understand that misrepresentation or omissions of material facts may remove me from further consideration for employment. In addition, if employed, any misrepresentation or omission of material facts called for in this application may be cause for dismissal any time without any previous notice.

I understand that, if I am employed, my employment with Caritas Hospice Care is “at-will”, which means that my employment is for no specific term and that either the employer or the employee is free to terminate the employment relationship at any time for any reason, or no reason at all. I further understand that no oral promise or representation, policy, custom, practice, or procedure constitutes an employment contract or modification of that at-will employment relationship between me and the employer.

The contents of any employee handbook or personnel manual, as well as any and all other employer practices, are subject to change at any time solely at the employer’s discretion, without notice. I also understand that no supervisor or other official (except the CEO, in writing) has the authority to enter into any agreement with me or to make any agreement contrary to the foregoing.

I understand that I Will be required to undergo screening for illicit drugs or alcohol abuse as part of a preemployment examination and that, in addition, all employees are subject to screen for illicit drugs or alcohol abuse.

Electronic Signature

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