About Hospice & Palliative Care of Iredell County

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Employment Application

Our staff is a unique team full of compassion, respect and integrity. If you desire to help HPCIC in fulfilling our mission of helping our patients and their families meet their end-of-life goals, we encourage you to complete our online employment application.

Should we determine that your qualifications and background align well with any opening that we may have, we will certainly be in contact with you. It is not necessary to place a phone call to the office.

Please remember that we do keep our applications on file for at least 12 months. Thank you for your interest in our organization.

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Personal Information
* Required Information
 
Desired Contact Method:
  • Home
  • Business
  • Cell
  •  
  • Email
Are you over 18?
  • Yes
  •  
  • No
If No, can you provide required proof of your eligibility to work?
  • Yes
  •  
  • No
After employment, can you submit proof of your U. S. citizenship or immigration status?
  • Yes
  •  
  • No
Have you ever been convicted of any crime?*
  • Yes
  •  
  • No
If Yes, please explain. (Conviction will not necessarily disqualify an applicant from employment.)
Are you willing to submit to drug testing at the direction of Hospice & Palliative Care of Iredell County?*
  • Yes
  •  
  • No

 

Employment Desired
* Required Information
 
How did you learn about Hospice & Palliative Care of Iredell County?*
  • Advertisement
  •  
  • Employment Agency
  •  
  • Friend
  • Relative
  •  
  • Walk-in
  •  
  • Other:  
Type of Prefered Status*
  • Full Time
  •  
  • Part Time
  • Temporary
  • Any
Per
  • Hour
  •  
  • Year
Have you ever applied for employment with us?
  • Yes
  •  
  • No
Are you willing to work
  • Saturdays
  •  
  • Sundays
  •  
  • Holidays
  • Overtime
  •  
  • Other
  •  

Hospice & Palliative Care of Iredell County, 2347 Simonton Road, Statesville, NC 28625 is an equal opportunity employer and does not discriminate in its employment practices on the basis of race, color, veteran status, gender, age, creed, religion, disability, or national origin.

This application will be given every consideration; its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this appliaction until all questions have been answered.

 

Education and Training
* Required Information
 
High School
  • Yes
  •  
  • No
Business/Trade/Tech School
  • Yes
  •  
  • No
College
  • Yes
  •  
  • No
Graduate School
  • Yes
  •  
  • No
Describe any specialized training, skills, apprenticeships and extracurricular activities. Also indicate any foreign language(s) you can speak, read and/or write:
List membership in Professional, trade, Business or Civic Organizations and offices held (exclude those which may reveal your gender, race, religion, national origin, age, disability or other protected status):
Did you serve in the U. S. Armed Forces?
  • Yes
  •  
  • No
If Yes, describe any training received relevant to the position to which you are applying:

 

Employment History
* Required Information
 

Start with your present or most recent employer. Give accurate, complete information accounting for all periods of time including military service and any periods of unemployment. Please give month and year.

Company
Duties Performed:*
Company
Duties Performed:
Company
Duties Performed:

 

Supplemental Employment Information
* Required Information
 
Are you presently employed?*
  • Yes
  •  
  • No
If Yes, may we contact your present employer?*
  • Yes
  •  
  • No
Have you ever been fired, or asked to resign, from a job?
  • Yes
  •  
  • No
Are you related to any current employee, volunteer, or board member at Hospice & Palliative Care Charlotte Region?*
  • Yes
  •  
  • No


 

References
* Required Information
 

Give three references listing name, address, phone number, and occupation. Do not list relatives or former employers.

 

 




Affidavit
  • I certify that my answers to the foregoing questions are true and correct without and consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form, any inserts/attachments or during any interviews may be grounds for immediate dismissal.
  • I hereby authorize Hospice & Palliative Care of Iredell County to contact any company or individual it deems appropriate to investigate my employment history, character, and qualifications. I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy, or any other reason because of their statements.
  • I agree that, if I am employed, I will abide by all the rules and regulations of Hospice & Palliative Care of Iredell County. I will also adhere to the CORE VALUES of Hospice & Palliative Care of Iredell County.
  • I understand this application shall be considered active for a period of time not to exceed ninety (90) days. If I wish to be considered for employment beyond this time period, I should inquire whether aplications are being accepted at that time.
  • By checking this box, I certify that I agree to the above statements.*


Release Authorization
* Required Information
Sex*
  • Male
  •  
  • Female
List Counties and States of residence other than that above, for the past seven years.
  • By checking this box, I certify that have read and agree to the above authorization.*