Orange Hospice

(714) 790-0594

Employment Application

    INSTRUCTIONS:

    If you need help filling out this application form or for any phase of the employment process, please notify the person who gave you this form and every reasonable effort will be made to meet your needs in a reasonable amount of time.

    • Please read "Applicant Note” below.

    • Complete all pages of this application.

    • Print clearly. Incomplete or illegible applications may not be accepted.

    • If more space is needed to complete any question, use comments section on the back.

    • Application will be valid for 60 days.

    APPLICANT NOTE:

    This application form is intended for use in evaluating your qualifications for employment with us. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment begins, terminating employment. All qualified applicants will receive consideration and will be treated throughout their employment without regard to race, color, religion, sex, national origin, age, disability, or any other protected class status under applicable law. Additional testing for the presence of illegal drugs in your body may be required prior to employment.

    PERSONAL INFORMATION

    Today’s Date:

    Positions(s) Applied For:

    License # (If Applicable)







    Emergency Contact(s):

    Valid Driver’s License #:







    Are you legally eligible for employment in the United States?
    Have you ever submitted an application here before?
    Have you ever been employed here before?


    Have you worked under any other names, if so please list:

    Have you read the job description for the position for which you have applied to review.
    Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accommodation?
    Why are you interested in employment with us?

    AVAILABILITY

    Due to the nature of the business, no guarantee can be made as to the schedule or the amount of hours worked.

    What date are you available to begin work?

    Please complete all areas of availability:

    Please indicate the days of the week as well as the earliest and latest times that you are available for work:

    PREFERENCES

    Please indicate all areas of the city in which you are willing to work:

    Are you willing to provide service to a client with a pet?:
    If yes, which ones:
    Are you willing to provide service to a client that smokes?:

    EDUCATION

    High School
    School Name, City, State, Major/Subject, # Yrs Attended

    Graduate

    Vocational/Technical
    School Name, City, State, Major/Subject, # Yrs Attended

    Graduate

    College/University
    School Name, City, State, Major/Subject, # Yrs Attended

    Graduate

    *For employment our minimum education requirement is either a GED or High School diploma

    WORK HISTORY

    Your application will not be considered unless all questions in this section are answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are essential.

    MOST RECENT EMPLOYER
    Are you currently working for this employer?:
    If yes, may we contact?:

    Company





    SECOND MOST RECENT EMPLOYER

    Are you currently working for this employer?:
    If yes, may we contact?:

    Company:





    THIRD MOST RECENT EMPLOYER

    Are you currently working for this employer?:
    If yes, may we contact?:

    Company:





    SECURITY
    As a condition of employment all employees must be “Bondable” & “Insurable”. Are you at least 19 years of age?:

    PROFESSIONAL REFERENCES (Do not include relatives):

    Please complete a minimum of 2 references. Please notify all references in advance. If we are unable to reach a minimum of 2 references, you will be asked to provide additional references.

    PROFESSIONAL REFERENCE 1




    PROFESSIONAL REFERENCE 2




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