Hospice Employment Lansing MI

Personal Information

Job Applying For*

First Name*

Preferred Name

Last Name*

Email Address*

Attachments

Cover Letter*

Resume*

Current Address

Country
---United StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (ROC)TajikistanTanzania, United Republic ofThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

Address*

Address #2

City*

State*
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip/Postal code*

Contact Information

Home Phone*

Cell phone*

General Information

Are you 18 years of age or older?*YesNo
If you are under age 18, can you furnish a work permit?YesNo
Are you legally authorized to work in the United States?YesNo

Available Start*

Do you have any relatives working at the location where you are applying?*YesNo

If yes, please give name and position:

Note: Answering yes to the following two questions does not automatically disqualify you for the position."

Have you ever been convicted of a crime?* YesNo
Have you ever been accused or arrested for physically, sexually, or emotionally abusing a child or an adult?* YesNo

If you answered yes to either question, please explain:

List any additional information you would like us to know about you. Include skills, licenses, certificates, or additional training you have relevant to the position:

Education and/or Military

High School

Name of School*

Location*

Last Grade Completed*
9101112

Graduate or GED?*
YesNo

College or University

Name of School

Location

Years Completed
1234

Graduate?*
YesNo

Course or Major

Degree

College or University 2

Name of School

Location

Years Completed
1234

Graduate?*
YesNo

Course or Major

Degree

Graduate School

Name of School

Location

Years Completed
123456

Graduate?*
YesNo

Course or Major

Degree

Military

Location

From

To

References

Please list three professional references.

1st Reference

Name

Relationship

Phone

Address

2nd Reference

Name

Relationship

Phone

Address

3rd Reference

Name

Relationship

Phone

Address

Employment History

Please provide the following requested information regarding your employment history: Include military service assignments and volunteer activities. You may exclude organization names that include race, color, religion, gender, national origin, ancestry, age, disability or other protected status.

Current or Most Recent Employer

Are you currently employed?* YesNo

Employer Name

City and State

Title

Start Date

End Date

Reason for leaving
TerminatedPromotedResignedLaid OffCurrently Employed

Explanation

Rate of Pay

Direct Supervisor

Company Phone

OK to contact? YesNo

Responsibilities and Duties:

2nd Previous Employer

Employer Name

City and State

Title

Start Date

End Date

Reason for leaving
TerminatedPromotedResignedLaid OffCurrently Employed

Explanation

Rate of Pay

Direct Supervisor

Company Phone

OK to contact? YesNo

Responsibilities and Duties:

3rd Previous Employer

Employer Name

City and State

Title

Start Date

End Date

Reason for leaving
TerminatedPromotedResignedLaid OffCurrently Employed

Explanation

Rate of Pay

Direct Supervisor

Company Phone

OK to contact? YesNo

Responsibilities and Duties:

Applicant's Statement

I certify that all information I have provided in this application is true, complete, and correct.

I expressly authorize, without reservation, Mother Teresa House, its representatives, employees, or agents to contact and obtain information from all references, employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé, or job interview. I hereby waive any and all rights and claims I may have regarding Mother Teresa House, its representative, employees and agents for seeking, gathering, and using such information in the employment process and all other persons, entities, or organizations for furnishing such information about me.

I understand that Mother Teresa House does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable law.

If I am hired, I understand that employment is at-will. I understand that I am free to resign at any time, with or without prior notice, and that Mother Teresa House reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required or prohibited by applicable law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that any handbooks, manuals, policies, and procedures maintained by Mother Teresa House are not contractual in nature and may be amended or abolished at the sole discretion of the hiring agent. I understand that no supervisor or representative of Mother Teresa House is authorized to make any assurances to the contrary and that no implied, oral, or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by an authorized representative of Mother Teresa House.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

The employer is a human service organization.

This human service organization is faith based. In both personal and professional life, an employee must exemplify the moral teachings of the Catholic Church. The employee must not teach, advocate, model, or in any way encourage beliefs or behaviors that are contrary to the dogmatic or moral teachings of the Catholic Church, which can be found in the Catechism of the Catholic Church.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient cause to (a) eliminate consideration of this application, or (b) immediately terminate my employment whenever it is discovered.

This application shall be considered active for a period of time not to exceed 90 days.

I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.

Applicant Signature*
Date*

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