Employment Application » Vantage Hospice

Name *

First

Middle

Last

Email *

Present Address *

Address Line 1

Address Line 2

City

State

Zip Code

How long have you resided at the address above? *

Social Security Number *

Phone Number *

If under 18, please list your age.

Can you, after employment, submit certification of your legal right to work in the United States *

Which position are you applying for? *

Add salary desired (be specific) *

How many hours can you work weekly? *

Can you work nights? *

Employment Desired. *

Full-Time Only
Part-Time Only
Full- or Part-Time

When are you available to start? *//

Check off all levels of schooling completed. *

High School
College
Business or Trade School
Professional School

Have you ever been convicted of a felony? *

Yes
No

Have you ever been convicted of a misdemeanor involving theft? *

Yes
No

Have you ever been convicted of a misdemeanor involving abuse, neglect, or mistreatment of an individual? *

Yes
No

This company will not deny employment to any applicant solely because the applicant has been convicted of a crime. The company will consider the nature, date, and circumstances of the offense as well as whether it is job related.

Please upload your current resume in PDF format here. *

Click or drag a file to this area to upload.

Please upload the completed DPS Computerized Criminal History Form (Available for Download Above) *

Click or drag a file to this area to upload.

Please upload the signed Criminal Background Check Release form (available for download above). *

Click or drag a file to this area to upload.

May we contact your present employer? *

Yes
No

Did you complete this application yourself? *

Yes
No

Do you have a driver's license? *

Yes
No

What is your means of transportation to work? *

Please include the names of 3 references other than relatives below.

Reference #1

Name of Reference 1 *

First

Last

Company *

Position *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #2

Name of Reference 2 *

First

Last

Company *

Position *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reference #3

Name of Reference 3 *

First

Last

Company *

Position *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

An application form makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. *

PLEASE READ THE FOLLOWING BEFORE SIGNING THIS APPLICATION FORM

I understand that employment at the Company is at will and that either the Company or I can terminate the employment relationship at any time, for any reason, with or without notice. I further understand that neither this application nor any other Company communication I may receive constitutes an employment contract. I authorize the Company and any employer or all of my references and former employers listed on the application I submitted. I release the Company and any employer or reference which is contacted from any liability arising out of such inquiry for the response of such inquiry. I certify that the statements contain heirs are true to the best of my knowledge and belief. I understand that any false or misleading statement, receipt or unsatisfactory references, an unsatisfactory criminal background check, or an unsatisfactory result of the post offer physical examination which reveals that I cannot preform the essential functions of my job with or without accommodation may result in ineligibility for hire and/or discharge.

Entering your name in the box below constitutes as your electronic signature. *

High School

College

Business or Trade School

Professional School

Reference #1

Reference #2

Reference #3

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