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Sugar Land Hospice

Compassionate Hearts Caring Hands

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Free In-Home Consultation 832-410-3194

  • Home
  • About
    • Coverage areas
    • Emergency Preparedness
    • Leadership team
    • Testimonials
  • Our Services
    • Grief Services
      • Coping Strategies That Work
      • What to Expect
    • Veterans Program
    • Health Care Professionals
    • Which Program is Right for You
    • In-home Health Care
  • Giving
  • Volunteer
  • Employment
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    • Enter Hospice Care
    • Hospice Settings
    • Levels of Care
    • Paying For Hospice
    • Planning And Decisions
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Home Jobs Listing Job Application

Job Application: Licensed Master Social Worker

Title: Licensed Master Social Worker

Fields marked with an asterisk (*) must be filled out before submitting.

Personal Information

Name (Last Name First) *
Email Address *
Address *
City *
State *
Zip Code *
Telephone *
Cell Phone *
Upload Resume *

Employment Information

Date You Can Start *
Salary Desired *
Are You Employed Now? * yes
no
If so, may we inquire of your present employer? * yes
no
Ever applied to this company before? yes
no
Where and When?

Education History

Name of High School
Years Attended
Did you graduate? yes
no
 
Name of College
Years Attended
Did you graduate? yes
no
Subjects Studied
 
Name of Trade, Business, Or Correspondence School
Years Attended
Did you graduate? yes
no
Subjects Studied

General Information

Subject of special study/research work.
Special Training
If you are a nurse, do you have a compact nursing license? yes
no
Special Skills
U.S. Military or Naval Service yes
no
Rank

Former Employers (Starting with last one first)

Name and Address of Employer
From
To
Salary
Position
Reason for Leaving
 
Name & Address of Employer
From
To
Salary
Position
Reason for Leaving
 
Name & Address of Employer
From
To
Salary
Position
Reason for Leaving

References(Give below the names of three persons not related to you, whom you have known for at least one year.)

Name
Email Address
Telephone
Years Known
 
Name
Email Address
Telephone
Years Known
 
Name
Email Address
Telephone
Years Known
 

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This online form does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act(ADA) and other relevant federal and state laws.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written notice regarding the use of these reports and will also obtain a separate and written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document upon hire.”

 
* I have read and comply with the authorization policy.

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* I have read and comply with the privacy policy.
 
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14520 Old Katy Road, Suite 99
Houston, TX 77079
832-410-3194

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