Seasons Hospice Employment Application
Seasons Hospice considers applicants for all positions without regard for race, color, religion, sex, national origin, age, marital or veteran status, creed, disability, status with regard to public assistance, sexual orientation, or any other legally protected status. Seasons Hospice is an Equal Opportunity Employer. Seasons Hospice maintains applications for six months. However, if you have changes in your employment history, address, or phone number, you will need to complete a new application.

(* Indicates Mandatory Fields)

Email address *
Name *
First and Last name
Your answer
Phone number
Your answer
Address
Street *
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
Position Information
Primary position applying for *
Secondary position applying for
How did you hear about this position?
Professional Licenses & Certifications
Please list all licenses or certifications that apply. The Expiration Date may be left blank for licenses or certifications which do not expire.
Your answer
License/Certificate Type
Your answer
License/Certificate Number
Your answer
State (U.S. Only)
Your answer
Country
Your answer
Expiration Date
MM
/
DD
/
YYYY
Availability
Date available to start *
MM
/
DD
/
YYYY
Number of hours per week *
Shift Availability *
Please check all that apply.
Required
Please specify any days or hours NOT available to work
Your answer
Employment History
Please list three most recent employers starting with the most current. Please list all details of employment in the space below.
Employer #1
Name of employer *
Your answer
Street Address, City, State, Zip Code *
Your answer
Position *
Your answer
Employment start date *
MM
/
DD
/
YYYY
Employment end date
MM
/
DD
/
YYYY
Reason for leaving
Your answer
Employer #2
Name of employer *
Your answer
Street Address, City, State, Zip Code *
Your answer
Position *
Your answer
Employment start date *
MM
/
DD
/
YYYY
Employment end date
MM
/
DD
/
YYYY
Reason for leaving
Your answer
Employer #3
Name of employer *
Your answer
Street Address, City, State, Zip Code *
Your answer
Position *
Your answer
Employment start date *
MM
/
DD
/
YYYY
Employment end date
MM
/
DD
/
YYYY
Reason for leaving
Your answer
Are there gaps in your work history? If yes, explain: *
Your answer
Education & Training
Institution name *
Your answer
Years attended *
Your answer
Major *
Your answer
Did you graduate? If no, explain: *
Your answer
Please list any other information about your professional background that you feel would be beneficial to the position you are applying for:
Your answer
Applicant Statement
Please read the following information carefully. By signing below, you are agreeing to the following:

1. I understand that the receipt of this application does not imply I will be employed nor does it indicate that there are positions available.
2. I understand that unless acted upon, this application will become inactive after 180 days. After that time, I will have to reapply to receive further consideration.
3. I hereby grant permission to investigate any of the information included in this application, agree to cooperate in such investigation and release from all liability or responsibility all persons, organizations, companies and corporations collecting and supplying such information together with any other information they may have regarding me whether or not it is in their records.
4. In making this application for employment, I understand that an investigation may be made whereby information is obtained through interviews with my references, including but not limited to former co-workers, supervisors, business associates, etc. or others with whom I am acquainted. This inquiry includes information as to my criminal record, reputation, professional credentials, and work ethics. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.
5. I understand that if I am hired, my employment will be at-will and may be terminated with or without cause and with or without notice at any time. I also understand that no employee of Seasons Hospice other than the Executive Director has authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing.
6. I authorize Seasons Hospice to deduct from my final paycheck(s) all monies due and owing to the agency.
7. I understand that if I am employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.
8. I certify the information included in this application is true and correct, and without consequential omissions of any kind.

Digital Signature *
Please type your first and last name. By signing below, you are agreeing to the above applicant statement.
Your answer
Date Signed *
MM
/
DD
/
YYYY
Optional: Please email your resume and cover letter to hr@seasonshospice.org
Include your name and position(s) applying to in email subject line.
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