Apply Online – Application Employment Application VNA & Hospice of the Southwest Region is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, religion, color, national origin, age, ancestry, gender, sexual orientation, marital status, veteran status, physical or mental impairment, medical condition or other legally protected status. Assistance in reviewing job opportunities and/or completing this employment application will be provided to persons with disabilities upon request.Personal InformationName* First Middle Initial Last Email* Enter Email Confirm Email Address* Mailing Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Daytime Telephone*Evening TelephoneDo you have your own transportation?*YesNoIs your vehicle insured?*YesNoDo you have a valid driver's license?*YesNoMaiden Name(s)/Aliases (Please list other names or aliases by which you have been known)Have you been previously employed by VNAHSR?*YesNoPrevious position(s)*PositionDates of Employment Employment PreferencesPosition Desired*Scheduling Preferences Full-Time Part-Time Per Diem Days Nights Evenings Overnights Weekends Salary DesiredSalaryPer HourPer YearHow did you hear about this position?*VNA & Hospice WebsiteRecruitment Website (Indeed/JobsInVT, etc.)Digital Ads OnlineSocial MediaNewspaperEmployee ReferralJob FairRadio/TVOtherPlease specify how you learned of this positionEducationClick on the + sign to add an institution.Education*InstitutionCity/State of InstitutionDegree/Area of StudyYears completedGraduated? YesNo Work History(List all part-time/full-time positions in reverse chronological order with present or most recent position first. Use additional space provided below if necessary.) Click on the + sign to add an employment recordEmployment History*Employer (Company Name)Employer Address (Mailing Address,City, State, Zip)Employer TelephoneSupervisor's NamePosition/DutiesReason for LeavingDate StartedDate EndedStarting SalaryEnding SalaryEmployment Status Full-TimePart-TimePer Diem Special Qualifications/Skills(List any additional skills or abilities you feel are relevant to the job for which you are applying. Include significant education, certifications, life and volunteer experiences.)Additional InformationHave you ever been excluded from participating in any federal health care program?NoYesIf yes, what is the date of reinstatement?* (Please be prepared to present OIG letter of reinstatement.) Are you prevented from becoming lawfully employed in this country because of visa or immigration status?NoYes(Proof of citizenship and/or immigration status is required upon employment.)AuthorizationI authorize all persons, schools, employers and organizations mentioned in this application to provide VNA & Hospice of the Southwest Region (VNAHSR) with any and all information requested by the agency. I voluntarily release such persons, schools, employers and organizations from all liability for providing such information.This Authorization* Authorizes VNAHSR to contact my present employer. DOES NOT authorize VNAHSR to contact my present employer. If employed by VNAHSR I will abide by its rules and regulations. I understand that each individual’s employment at VNAHSR may terminate the employment relationship at any time for any reason, or for no reason with or without notice, at its option. Any oral or written statement by any member of company management which contradicts the “at-will” nature of the employment relationship as expressed herein is unauthorized and of no validity with the exception of a written statement made by the Executive Director. VNAHSR specifically reserves the right to add to, delete from and modify personnel policies at its sole discretion at any time. Detailed information concerning company policies may be obtained by contacting Human Resources. I understand that I will be asked to take a physical examination after an employment offer has been made and at any time during my employment at the option and expense of the company. I understand that medical records will be released only when required by law or subpoena, when authorized by myself in writing, or when a health care professional determines that I might cause harm to myself or others. I understand that a Vermont Criminal Information Center, Office of Inspector General, Adult and Child Abuse Protection Registry Check shall be required upon an offer of employment. All offers of employment are conditional based on the outcome of pre-employment physical, background and reference checks. All the foregoing information supplied in the application is true and a full and completed statement of facts to the best of my knowledge. I understand that if any misrepresentation or falsification is discovered, it will constitute grounds for discharge. I understand that this application is neither an offer of nor a contract of employment nor is any provision in this application to be considered contractual in nature. Please ensure that all information is complete before signing. Incomplete applications will not be accepted.Type your complete legal name in this box to serve as your official electronic signature.*EmailThis field is for validation purposes and should be left unchanged. 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