Employer InformationEmployer: Trail Winds Hospice: 75 Manhattan Dr, Suite #1 Boulder, CO 80303 Telephone: 303-442-5683It is the policy of Trail Winds Hospice to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.Application Information Applicant Full Name: Home Address: City, State, ZIP: Daytime phone: Evening phone: Mobile Phone: Email address: Job position applied for: Full or part time? Salary desired: $ per Who referred you to our company? Do you have any friends or relatives who work here? If yes, please list here: Are you at least 18 years old? YesNo Are you willing to work any shift, including nights and weekends? YesNo If no, please state any limitations: If applicable, are you available to work overtime? YesNo If you are offered employment, when would you be available to begin work? If hired, are you able to submit proof that you are legally eligible for employment in the United States? YesNo Applicant's Education and Training Please indicate any current professional licenses or certifications that you hold: Awards, honors, special achievements: Upload Resume CERTIFICATION I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Trail Winds Hospice to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS. Applicant signature Date
