800-767-4965

Our mission is to enable people to live with dignity and hope while coping with loss and terminal illness.

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Application for Employment

Please fill out the form below or download and submit to the main office.

We are an equal opportunity employer.

Job Questionnaire

(Conviction will not automatically disqualify you from employment since the nature of the offense and type of job for which you are applying will be considered.)

(A yes answer will not automatically disqualify you from employment)

Education/Qualifications
High School GED
Technical School
College
Optional Registration Requirements

If you are applying for a position that requires a registration, license or certificate, (includes HHA, LPN, RN, SW) please complete the following

NOTE: Satisfactory driving record and proof of auto insurance coverage will also be required.

References

Give three work/professional references who are not related to you.

3.
2.
1.
Experience
Please list all previous employment for the past 10 years. Begin with your last or present employment.

If more room is needed, please attach a separate sheet or resume.

3.

Please list job duties and responsibilities.

4.

Please list job duties and responsibilities.

2.

Please list job duties and responsibilities.

1.

Please list job duties and responsibilities.

I certify that answers given herein are true and complete to the best of my knowledge.
Any job offer may be conditioned upon the applicant passing a drug screen and pre-employment physical. Harry Hynes Memorial Hospice also has a policy of drug testing existing employees under various circumstances. Job offers may also be contingent upon satisfactory record checks including but not limited to criminal background and motor vehicle records (for positions requiring a driver’s license).
I hereby authorize my present and previous employers and listed references to release to Harry Hynes Memorial Hospice any and all records of my service and other information concerning me in their records. Further, I hereby release them, their employees and Harry Hynes Memorial Hospice from all liability for any damage whatsoever for providing and obtaining same.
I hereby acknowledge that any employment relationship with this company is of an "at will" nature, which means that the employee may resign at any time and the employer may discharge the employee at any time with or without cause. It is further understood this "at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of the company.
In the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

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