Personal Information
Name *
Current Address *
Current Address
Phone *
General Information
Are you either a U.S. citizen or an alien authorized to work in the United States? *
Have you ever been convicted of a felony? *
Do you have a valid driver's license? *
Have you ever applied or worked for Healing Care Hospice before? *
Are you currently employed? *
Education Background
Did you Graduate? *
Did you Graduate?
Did you Graduate:
Please List (3) References that are not related to you.
Phone Number: *
Phone Number:
Phone Number: *
Phone Number:
Phone Number: *
Phone Number:
Employment History
Please list your previous employers, starting with present or most recent employer.
Telephone Number: *
Telephone Number:
May we contact? *
Telephone Number:
Telephone Number:
May we contact?
Applicant's Statement
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I understand that nothing contained in the application or conveyed to me during any interview which may be granted is intended to create an employment contract, implied or explicit, between me and the Healing Care Hospice. I understand and agree that if I am employed, my employment relationship with the Healing Care Hospice is strictly voluntary and at our mutual will. I understand that the Healing Care Hospice follows an “employment at will” policy, in that I or the employer may terminate my employment at any time or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the President/CEO of this organization.
I understand that if offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States on the first day of employment.
If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid TN driver’s license and understand that I will be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent on my ability to be covered by the Healing Care Hospice auto insurance, if required for my position.
My signature below certifies that I have read and understand this complete page, and agree to the terms and conditions outlined in this document.