What days are you unable to work? *
Are you willing to travel? *
If yes, what percent of time ? *
Are you willing to work hours other than 8-5? *
Have you ever been convicted of a felony or subjected to deferred adjudication on felony charge ? *
If your answer is "yes" explain in concise detail . Give dates and nature of the offense, name and location of the court, and disposition of the case(s). A conviction may not disqualify you, but a false statement will
Education: NOTE ( Applicants may be required to provide proof of diploma, deree, transcripts, license, certifications and registrations)
High School Graduate or GED? *
If yes, name /location of high school or GED institute:*
License/ Certification: If a license , certificate, or other authorization is required or related to the position for which you are appling, complete the following
License/Certificate/registration*
Skills: Special Training/Skills/ Qualifications: List all job related training or skills you possess and machine or office equipment you can use, such as calculators, printing or graphic equipment, computer equipment, types of software and hardware . *
Do you speak a language other than English? *
If yes, what language(s) do you speak? *
Do you use sign language ? *
Have you ever been employed by Road to Happiness Hospice ? *
Do you have any relatives employed by Road to Happiness Hospice ? *
If yes, name and relationship*
Military Services( A copy of a report of separation from the Armed Services may be required.)
If yes, list the type of discharge:
Dates of Services : From/To
References: Name three(3) persons ( not related) who have knowledge of your professional qualifications and whom we have permission to contact. Preferably persons under whom you have worked.*
Employment History : List all employment since graduation (present or most recent position first)
I certify that the information given on this application and in any other supporting documentation, resume, etc. is true and correct. I understand that any false information , willful or negligent misrepresentation , or failure to disclose any requested information will constitute sufficient grounds the employer to terminate my employment without notice. I authorize my previous employer, school, or person named as reference to give any information regarding my employment together with information they may have regarding me, whether or not it is on their records. I agree that the named company and my previous employer shall not be held liable in any respect if an employment off is not tendered, is withdrawn or my employment is terminated because of falsity of statement , answers or omissions made by whatsoever for issuing this information
