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+1 (706) 647-2273

info@thomastonhospice.com
+1 (706) 646-3858

Fax number
512 S Center Street

Thomaston, GA 30286
24 Hour Nurse Coverage

7 Days A Week

 

Employment

Work with us

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.

Application for Employment

Please fill out this form if you are interested

    Personal Information

    First Name*

    Last Name*

    Current Address*

    City

    State

    Zip Code

    Permanent Address (if different)

    City

    State

    Zip Code

    Home Phone

    Alternate Phone

    Email

    Birth Date*

    Are you over 18 years of age?
    YesNo

    Referred By*

    Employment Desired

    Position

    Date you can Start*

    Desired Salary (amount per hour or per year)

    Are you currently employed?
    YesNo

    If so, may we inquire of your present employer?
    YesNo

    Have you previously applied here?
    YesNo

    If so, when did you apply?

    Education

    Grammar School Name

    Grammar School Address

    Did you Graduate?
    YesNo

    High School Name

    High School Address

    Did you Graduate?
    YesNo

    College Name

    College Address

    Did you Graduate?
    YesNo

    Subject(s) Studied and Degree(s) Received

    Subjects of Special Study or Research Work

    Job Related Skills (typing, driver's license, etc.)

    Activities Other Than Religious (Civic, Athletic, etc.)

    Former Employers

    List below you last four employers, starting with the last one first.

    Employer 1

    Employer Name

    Start Date

    End Date

    Employer Address

    City

    State

    Zip Code

    Salary Upon Leaving

    Position

    Reason For Leaving

    Employer 2

    Employer Name

    Start Date

    End Date

    Employer Address

    City

    State

    Zip Code

    Salary Upon Leaving

    Position

    Reason For Leaving

    Employer 3

    Employer Name

    Start Date

    End Date

    Employer Address

    City

    State

    Zip Code

    Salary Upon Leaving

    Position

    Reason For Leaving

    References

    Reference 1
    Reference Name #1

    Employer Address

    City

    State

    Zip Code

    Contact Number

    Years Acquainted

    Reference 2
    Reference Name #2

    Employer Address

    City

    State

    Zip Code

    Contact Number

    Years Acquainted

    Reference 3
    Reference Name #3

    Employer Address

    City

    State

    Zip Code

    Contact Number

    Years Acquainted

    If you are to be hired by this company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

    I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.

    I understand that any employment is conditioned on a background check. I authorize the company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

    I understand and agree that nothing contained in this application, conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

    If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law is contingent upon satisfactory medical examinations and drug test, and If I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy.

    I understand that filling out this form does not indicate there is a position open and does not obligate the company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies of procedures, in whole or in part, at any time.

    E-Signature

    Date