Apply Online – EEO EEO Statement Equal Employment OpportunityThe VNA & Hospice of the Southwest Region is committed to providing Equal Employment Opportunity to all persons without regard to race, color, religion, sex, sexual preference, national origin, disability or any other non merit factor, or age as define d by Federal and State Law. In order to evaluate the effectiveness of our recruitment efforts, the following information is requested on a voluntary basis. The following information will be kept strictly confidential and used solely for reporting purposes referenced above.Harry L. Snyder, Human Resources DirectorApplicant Name (optional) & Position / Department Desired Name (optional) Department/Position Desired GenderMaleFemaleRacial or Ethnic Group Native American: American Indian or Alaskan Native. All person having origins in any of the original peoples of North America and maintaining identifiable tribal affiliations through membership and participation or community identification. Asian / Pacific: Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent or the Pacific Islands (e.g. China, Japan, Korea and Samoa). Black: Persons having origins in the black racial groups of Africa not of Hispanic origin. Hispanic: Persons having origins in Mexico, Puerto Rico, Cuba, Central or South America or other Spanish culture or origin, regardless of race. White: Persons having origins in any of the original peoples of Europe, North Africa or the Middle East. Vermont Statutes (21 V.S.A. S495d.) “An individual with a disability” means any natural person who (A) has a disability which substantially limits one or more major life activities; (B) has a history or record of such an impairment.Do you have a disability?YesNoMilitary ServiceBranch of MilitaryServed from this date Served to this date Type of DischargeHonorableGeneralMedicalDishonorableDid you serve in the National Guard / Reserve?YesNoDid you serve more than 180 days of Active Duty?YesNoHave you served in a Hostile Fire Area?YesNoIf yes, where?Do you have a Service Connected Disability?YesNoIf yes, what percentage?Are you the spouse of a service member?YesNoDoes your spouse have a TOTAL disability?YesNoWas your spouse missing in action?YesNoWas your spouse captured/detained by hostile forces?YesNoDid your spouse die while on active duty?YesNoElectronic SignatureToday's date Seven Albert Cree Drive • Rutland, Vermont 05701 • (802) 770-1510 • (802) 775-2304 - FAXNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.