Employment Application

Please fill out the form below to apply for a position with us. Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law. We are an equal opportunity employer.

If you do not wish to apply online, you can find a PDF application here.

Labels marked with * denote required fields.

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip: *

Phone: *

Are you under 18 years of age?: *

Yes: No:

Email: *

Availability: *

Days: Evenings: Nights: Weekends:

Salary expected: *

Position: *

Click here to view descriptions.

If other: *

Education

Highest grade completed: *

Other grade completed:

School name/city/state *	Major classes completed *	Did you graduate? *	Diploma/degree *
		Yes: No:
		Yes: No:
		Yes: No:
		Yes: No:

Skills

Proficient in software?

Yes No

Computer Software/Applications You Have Used:

Typing?

Yes No

WPM:

10 key touch?

Yes No

Medical terminology?

Yes No

Foreign languages spoken:

Special Skills or Training:

Employment History

Begin with your most recent experience, and list the rest chronologically.

Employer:

Address:

From (mm/yyyy):

To (mm/yyyy):

Supervisor:

Telephone:

Salary:

Job titles/duties:

Reason for leaving:

Employer:

Address:

From (mm/yyyy):

To (mm/yyyy):

Supervisor:

Telephone:

Salary:

Job titles/duties:

Reason for leaving:

Employer:

Address:

From (mm/yyyy):

To (mm/yyyy):

Supervisor:

Telephone:

Salary:

Job titles/duties:

Reason for leaving:

It is the policy of LightBridge Hospice to check an employee's Department of Motor Vehicle's driving record upon hire
and on an annual basis. An individual will not be eligible for hire or continued employment if they:

Have had more then three (3) moving violations or more than one chargeable accident in the past thirty-six (36) months.
Have had a major conviction (driving under the influence of alcohol or drugs) within the past seven (7) years.

Please read

The facts set forth in my application for employment are true and complete. I understand that if employed, false statements or omissions on this application will usually result in termination of employment. I understand that an offer of employment is contingent upon satisfactory proof of lawful employment status as set forth in the Immigration Reform and Control Act. Permission is hereby given to the Company to investigate previous employment, educational background and references. I release the Company and former employers from any liability resulting from any lawful information provided which may result in withdrawal of an employment offer or termination. I also understand that I am not eligible for employment with LightBridge if I am at any time, subject to exclusion from participating in any federally funded health care program.

I understand that the Company has a policy prohibiting conflicts of interest or improper use of proprietary information which prohibits any release or use of Company property that would interfere with the business interests or operations of the Company. I understand that employment with the Company is at will and may be terminated at any time by either the Company or myself with or without cause.

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Employment Application

Education

Skills

Employment History

Personal information

Have you ever had any criminal conviction relating to:

Please read

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