Employment Application

Employment Application
Volunteer Hospice of Clallam County (VHOCC) is an equal opportunity employer dedicated to a policy of non-discrimination in employment (including application for employment) on any basis including race, color, religion, national origin, ancestry, citizenship, sex, age, physical or mental disability, medical condition, pregnancy, veteran or military status, or any other basis prohibited by local, state, and federal law.

Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. Reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on Volunteer Hospice of Clallam County. Please contact Volunteer Hospice of Clallam County if you need assistance completing this application or to otherwise participate in the application process.

Please read and answer all questions carefully. Your failure to respond to all questions may disqualify this application from further consideration. All information must reflect a complete and accurate record of your education and employment history.
Personal Information
Name*

First NameLast Name
List any other names you would be known by in employment or education records
Present Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Email For Contact*
example@example.com
Alternate Email
example@example.com
Primary Phone Number For Contact*
Please enter a valid phone number.
Alternate Phone Number 1
Please enter a valid phone number.
Alternate Phone Number 2
Please enter a valid phone number.
Position Applying For*
Are you legally authorized to work in the United States?*

YesNo
Are you at least 18 years of age?*

YesNo
Will you (now or in future) require sponsorship for immigration-related employment benefit*

YesNo
Date Available To Start With VHOCC*

MonthDayYear
Date
Will you relocate if necessary?*

YesNoNot Applicable
Wage Desired:
Available to work*

Full TimePart TimePer DiemContract
Previously applied to VHOCC?*

YesNo
Previous Position Applied For
How did you learn about this opportunity?
If referred by a current employee, name of employee

Education Information Section
Education

Please list your educational background beginning with High School. Include technical school, military training, etc. If your resume contains the information requested in this section, please skip to the next section of this application.
1) Name of School
1) Location of School
1) Major/Degree
1) Graduated

YesNo
2) Name of School
2) Location of School
2) Major/Degree
2) Graduated

YesNo
3) Name of School
3) Location of School
3) Major/Degree
3) Graduated

YesNo
4) Name of School
4) Location of School
4) Major/Degree
4) Graduated

YesNo
List any vocational or business-related courses & trainings:

Employment & Work Experience Section 1
Employment/Work Experience Part 1

List employment history (~10 years) starting with your current/most recent employer. Include military service & self-employment. If your resume contains the information requested in this section, please skip to the next section of this application.
1) Employer
1) Position Held
1) Employer Phone #
1) Employer Email
1) Supervisor Name
1) Supervisor Title
1) Employment Start Date
1) Employment End Date
1) Reason for leaving:
1) May we contact this employer?

Yes, prior to an offer of employment being madeYes, only after an offer of employment is madeNo, I would prefer if you did not contact this employer
2) Employer
2) Position Held
2) Employer Phone #
2) Employer Email
2) Supervisor Name
2) Supervisor Title
2) Employment Start Date
2) Employment End Date
2) Reason for leaving:
2) May we contact this employer?

Yes, prior to an offer of employment being madeYes, only after an offer of employment is madeNo, I would prefer if you did not contact this employer
3) Employer
3) Position Held
3) Employer Phone #
3) Employer Email
3) Supervisor Name
3) Supervisor Title
3) Employment Start Date
3) Employment End Date
3) Reason for leaving:
3) May we contact this employer?

Yes, prior to an offer of employment being madeYes, only after an offer of employment is madeNo, I would prefer if you did not contact this employer

Employment & Work Experience Section 2
Employment/Work Experience Part 2
Have you been dismissed or asked to resign from any position?*

YesNo
If you have been dismissed or asked to resign from a position, please explain:
Identify and explain any gaps in employment that were greater than 90 days.
1) From

MonthDayYear
Date
1) To

MonthDayYear
Date
1) Reason for employment gap
2) From

MonthDayYear
Date
2) To

MonthDayYear
Date
2) Reason for employment gap

File Uploads
Please upload a copy of your resume*

Cancelof
Cover Letter: If you would like to add a cover letter with your application, please upload here.

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Professional References
1) Name of Reference

First NameLast Name
1) Reference Phone Number
Please include area code
1) Reference Email
example@example.com
1) Job Title
1) Relationship to you
2) Name of Reference

First NameLast Name
2) Reference Phone Number
Please include area code
2) Reference Email
example@example.com
2) Job Title
2) Relationship to you
3) Name of Reference

First NameLast Name
3) Reference Phone Number
Please include area code
3) Reference Email
example@example.com
3) Job Title
3) Relationship to you

Save or Submit
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