Job Application

HOOSIER HOME HEALTH

An Equal Opportunity Employer

Hoosier Home Health is always accepting applications because we are always caring for new patients!

Please fill out an application below and someone will contact you as soon as possible.

Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered.

We do not discriminate on the basis of age, race, sex, color, religion, national origin, disability, or any other applicable status protected by state or local law. It is our intention that all qualified applicant be given equal opportunity and that selection decisions be based on job-related factors.

Job Applying For: (LPN, RN, HHA, etc.)

Other

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Upload Resume

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are You 18 Years Of Age? (If you are hired you may be required to submit proof of age.)

What License Do You Currently Hold?

Are you seeking:

When could you start work?

Date

What Shifts Do You Prefer?

If hired, can you furnish proof you are eligible to work in the U.S.?

Have you ever applied here before?

If yes, when?

Were you ever employed here?

If yes, when?

Mark All That Applies

Rows	1 Year	2 Years	3 Years	Graduated
GED
High School
Trade School
University

If You Completed University Please Fill Out Information Below

What skills or additional training do you have that are related to the job for which you are applying?

Give three references, not relatives or former employers complete with namexs addresses and phone numbers.

Are you presently employed?

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre and/or post employment drug screen as a condition of employment, if required.I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. I have read, understand, and by my signature consent to these statements.