All applicants are required to complete are required to complete and submit this Employment Application. Anchor does not discriminate based on sex, age, color, race, religion, marital status, national origin, ancestry, sexual orientation, physical & mental disability, mental condition, generic information, veteran status, or any other basis protected by federal, state, or local law.

APPLICANT INFORMATION :

Legal Name
COMPLETE HOME ADDRESS (INCLUDE PO BOX, APT #, ETC.)

POSITION APPLYING FOR :

IF NECESSARY, ARE YOU AVAILABLE TO WORK ANY OF THE FOLLOWING?

EDUCATION: BEGIN WITH MOST RECENT COLLEGE/UNIVERSITY/TECHNICAL SCHOOL

SECURITY

(A) This Security Section must be completed by all applicants. EXCEPT FOR THOSE APPLICANTS IN HAWAII, MASSACHUSETTS, AND THE CITY OF PHILADELPHIA, PA. Under Hawaii and Massachusetts state law and Philadelphia Bill 10111-A, an employer is prohibited from making written, pre-employment inquiries of an applicant about his or her criminal history. HAWAII, MASSACHUSETTS, AND THE CITY OF PHILADELPHIA, PA APPLICANTS SHOULD NOT, AND MUST NOT ANSWER ANY TYPE OF QUESTIONS IN THE SECURITY SECTION. RATHER, HAWAII, MASSACHUSETTS, AND THE CITY OF PHILADELPHIA, PA SHOULD SKIPTHIS SECTION ENTIRELY AND PREOCEED DIRECTLY TO THE EMPL0YMENT HISTORY SECTION IN THIS APPLICATION. Florida applicants should complete this Security Section (a) AND section (b) below. HAE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR PUNISHANLE BY 6 MONTHS OR MORE OF INCARCERATION WITHIN THE LAST 7 YEARS? (You do not need to disclose: convictions for misdemeanor marijuana-related offenses more than two years old; convictions that have been sealed, expunged or legally eradicated (such as juvenile offenses); participation in pre- or post-trial diversion; a discharge under the Georgia First Offenders Program; or misdemeanor convictions for which probation was completed successfully or otherwise discharged and the case was dismissed.)
If yes, please describe the nature of the offense(s), the date and place of conviction, and the legal disposition of the case. Anchor Hospice will not deny employment to any applicant solely because the person has been convicted of a crime. Anchor Hospice, however, may consider the nature, date and circumstances of the offense as well as whether the offense is relevant to the duties of the position for which you are applying. (B) FOR FLORIDA APPLICANTS (1) Have you ever been a defendant in a civil action for intentional tort? (An intentional tort for a civil wrong resulting from an intentional act. Example of an intentional tort include assault, battery, false imprisonment, and intentional infliction of emotional distress)
(2) If yes, please describe the nature of the intentional tort and the disposition of the action.
EMPLOYMENT HISTORY : LIST CURRENT/MOST RECENT POSITION FIRST (ATTACH ADDITIONAL SHEETS IF NECESSARY.
DATE EMPLOYED
SALARY
DATE EMPLOYED
SALARY
DATE EMPLOYED
SALARY
DATE EMPLOYED
SALARY

REFERENCES: List three people (other than relatives) who are in a position to evaluate your previous employment performance, preferably former supervisors or people with whom you have worked. (If applying for a supervisory position, please include one subordinate.)

PLEASE READ BELOW CAREFULLY AND THEN INITIAL NEXT TO EACH PARAGRAPH.PLEASE SIGN AND DATE IN THE SPACE PROVIDED AT THE BOTTOM OF THIS PAGE

APPLICANT’S INITIALS
CERTIFICATION AND RELEASE

EMPLOYMENT OPPORTUNITIES FORM