Want to work with us? Fill out the employment application below to get started. Employment Application Last Name First Middle Address City State Zip Preferred Phone Number Type of phone Type of phone Home Phone Cell Phone Alternate Phone Number Type of phone Type of phone Home Phone Cell Phone Email Address Are you 18 years old or older? Are you 18 years old or older? Yes No Age Are you legally eligible for employment within the United States? Are you legally eligible for employment within the United States? Yes No Have you ever been convicted of a felony? Have you ever been convicted of a felony? Yes No If yes, explain Do you have any relatives employed by Faith Hospice? Do you have any relatives employed by Faith Hospice? No Yes If yes, who? Have you ever been employed by Faith Hospice? Have you ever been employed by Faith Hospice? Yes No If yes, when? How were you referred to us? Position Applying For Salary Desired Are you applying for Are you applying for Full Time Part Time Temporary Date Available for Work Would you consider working Would you consider working Full time Part time Temporary High school attended/address High school course of study Last year of high school completed Did you graduate? Did you graduate? Yes No College attended/Address College course of study List diploma, degree, or #hours Last year of college completed Did you graduate? Did you graduate? Yes No College attended/Address College course of study List diploma, degree, or #hours Last year of college completed Did you graduate? Did you graduate? Yes No Special courses, military training, post grad, etc. Area of specialization or special interest Are you currently Are you currently Registered Licensed Certified Are you eligible for Are you eligible for Registration Licensure Certification License or Certification type 1 State issued Date Expiration Date License or Certification Number License or Certification type 2 State issued Date Expiration Date License or Certification Number License or Certification type 3 State issued Date Expiration Date License or Certification Number Employed From (Most Recent) Employed To (Most Recent) Last Salary Reason for leaving Job Title Duties/Responsibilities Employer Name Immediate Supervisor Telephone Number Address City/State Zip Code Employed From Employed To Last Salary Reason for leaving Job Title Duties/Responsibilities Employer Name Immediate Supervisor Telephone Number Address City/State Zip Code Employed From Employed To Last Salary Reason for leaving Job Title Duties/Responsibilities Employer Name Immediate Supervisor Telephone Number Address City/State Zip Code Employed From Employed To Last Salary Reason for leaving Job Title Duties/Responsibilites Employer Name Immediate Supervisor Telephone Number Address City/State Zip Code Branch of Military Service Served from Served to Branch at discharge Type of discharge If other than honorable, please explain Professional Reference Name/Title Company Name/Address Phone Professional Reference Name/Title Company Name/Address Phone Professional Reference Name/Title Company Name/Address Phone TERMS OF AGREEMENT: I certify that the information contained in this application is true and correct to the best of my knowledge and agree to have any of the statements checked by Faith Hospice unless I have indicated to the contrary. I authorize the references listed above to provide Faith Hospice any and all information concerning my previous employment and pertinent information that they may have. Further, I release all parties and persons from any and all liability of all damages that may result from furnishing such information to Faith Hospice or any of its agents, employees or representatives. I understand that any misrepresentation, falsification or material omission of information on this application may result in failure to receive an offer, of if am hired, in my dismissal from employment. In consideration of my employment, I agree to confirm to the rules and standards of the company and agree to my employment and compensation can be terminated at will, with or without cause, and with or without notice at any time, either at my option or at the option of the company. TERMS OF AGREEMENT: I certify that the information contained in this application is true and correct to the best of my knowledge and agree to have any of the statements checked by Faith Hospice unless I have indicated to the contrary. I authorize the references listed above to provide Faith Hospice any and all information concerning my previous employment and pertinent information that they may have. Further, I release all parties and persons from any and all liability of all damages that may result from furnishing such information to Faith Hospice or any of its agents, employees or representatives. I understand that any misrepresentation, falsification or material omission of information on this application may result in failure to receive an offer, of if am hired, in my dismissal from employment. In consideration of my employment, I agree to confirm to the rules and standards of the company and agree to my employment and compensation can be terminated at will, with or without cause, and with or without notice at any time, either at my option or at the option of the company. I agree to the terms of agreement 13 + 14 = Submit