The Hospice Care Center

Apply

Please fill out the application form and submit it, along with your resume, in the form below.

Your application will remain active for six months, at which time you will need to complete another application if you are still interested in employment. If you have questions or need assistance, please contact the Human Resources Department at (606) 759-4050.

English
If you speak Spanish or Chinese, language assistance services, free of charge, are available to you. Call 1-888-808-9008. PIN 78130232

Spanish
Si habla español, tiene a su disposición servicios gratuitos de asistencia lingü.stica. Llame al 1 (888) 808-9008 ALFILER 78130232

Chinese
注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1 (888) 808-9008 销78130232 Please be sure to sign and date the application on the last page.

Hospice Of Hope Application For Employment

Revised: 05/10/2021

It is Hospice of Hope’s policy to comply with all applicable local, state, and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, veteran status, and other categories protected by law. Equal access to programs, services, and employment is available to all persons. Those applicants requiring accommodations to the application and/or interview process should contact a Human Resource representative. A criminal background check is a condition of employment.


Information
Position(s) applied for
Date of Application
Referral Source
Name of Referral Source (if applicable)
First Name
Last Name
Address
City
State
Zip Code
Phone
Email
May we contact you at work?
Are you over 18 years of age?
If under 18 years of age, can you furnish a work permit?
Have you filed an application with Hospice of Hope before?
If yes, provide date and position
Have you ever been employed with Hospice of Hope?
If yes, provide employment dates and position
Are you legally eligible for employment in the United States?
Do you have any relatives working for Hospice of Hope?
If yes, provide names and relationship
State briefly why you would like to work for Hospice of Hope
Date available for work
Do you have any experience with terminally ill and/or bereaved persons?
If yes, briefly explain
Type of employment desired
Wage or salary desired
Will you relocate if job requires?
Will you travel if job requires?
Have you been informed of the essential functions of the job or have you been shown a copy of the job description listing the essential job functions?
Are there any hours, shifts or days you cannot or will not work?
If yes, briefly explain
Have you ever been convicted of a felony?
If yes, briefly explain

Employment History
Most Recent Employer
Address
Phone
May we contact for reference?
Starting Date
Starting Salary
Starting Position
Ending Date
Ending Salary
Ending Position
Name and Title of Supervisor
Description of Duties
Reason for Leaving

Previous Employer
Previous Employer
Address
Phone
May we contact for reference?
Starting Date
Starting Salary
Starting Position
Ending Date
Ending Salary
Ending Postition
Name and Title of Supervisor
Description of Duties
Reason for Leaving

Professional Licensure For Clinical Staff
License Number
State
Expiration Date

Skills And Qualifications
Summarize any special training, skills, licenses, certificates and/or characteristics of yourself
Educational Background
High School
Name & Address
Year Attended
Major
Degree
College/University
Name & Address
Year Attended
Major
Degree
Other Education
Name & Address
Year Attended
Major
Degree

School or Personal References (No Relatives)
Reference One
Name
Address
Phone
Years Known

Reference Two
Name
Address
Phone
Years Known

Reference Three
Name
Address
Phone
Years Known

Professional or Business References
Reference One
Organization
Offices Held
Reference Two
Organization
Offices Held

Other
List special accomplishments, publications, awards
List any additional information you would like us to consider

Please read the statement at the beginning of the form before signing below. If there is any part of this statement you do not understand, please ask the director of administrative services or the interviewer about it before signing this statement.
Signature
Date
Please upload the following documents
Resume:
Cover Letter: