Careers Application






Fields marked with * are required.

Position applying for:

Personal Information

First Name *

Last Name *

Address *

City *

Zip *

Email *

Phone *

Cell Phone

Are you a U.S. Citizen or authorized to work in the United States on an unrestricted basis: *
YesNo

If applicable, please list your visa type, visa # and expiration:

Have you ever been convicted of a felony: *
YesNo

If you answered YES, please explain:

Have you ever served in the U.S. Military:
YesNo

If YES, please provide the following information:

Branch of Service

Rank at time of separation

Time served from

to

Special Honors

Education

High School

Name

Address

Did you graduate
YesNo

Attended From

to

If you did not graduate, did you receive your GED
YesNo

Special honors or awards

Technical or Vocational School

Name

Address

Did you graduate
YesNo

Attended From

to

Degree or Certification

Specialty

Special honors or awards

College or University

Name

Address

Did you graduate
YesNo

Attended From

to

Degree

Special honors or awards

Position Information

How did you hear about this job

What hours are you willing to work

Would you be able to work weekends
YesNo

Are you willing to travel for this job
YesNo

When would you be able to start

Desired salary

Computer Skills

Languages spoken (other than English)

Any other pertinent information

Employment History

Present or Most Recent Employer

Employer

Address

Your Position

Salary

Duties

Date Started

Date Ended

Supervisor name and title

May we contact
YesNo

Reason for leaving

Former Employer

Employer

Address

Your Position

Salary

Duties

Date Started

Date Ended

Supervisor name and title

May we contact
YesNo

Reason for leaving

Professional References

Reference 1

Name

Company Name

Company Address

City, State & Zip

Phone

Applicants Position

Applicants date of employment

Reference 2

Name

Company Name

Company Address

City, State & Zip

Phone

Applicants Position

Applicants date of employment

Applicant Agreement

I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior educational and employment history.
Futhermore I understand that if I am hired, employment with this company is “at will,” which means that either the company or I can terminate my employment for any reason not prohibited by state or federal law.

Agree to Terms:
I agreeI disagree

Signature


Mission Statement

At Hospice of Southwest Ohio, we are dedicated to providing quality comfort care and support in meeting the medical, emotional, spiritual and psychological needs of our patients, families, caregivers, staff and community in a way that affirms life and supports choices in an environment of dignity and respect. HSWO’s caring employees and volunteers are empowered to fulfill this vision…with every patient…every day.


Volunteer

Interested in volunteering at the Hospice of Southwest Ohio? Find out how to apply and volunteer today.


Learn More

Help Support Our Foundation

The Hospice of Southwest Ohio Foundation is a 501(c)(3) charitable foundation. Find out how you can help today.


Learn More