To the applicant: Hospice of Randolph County is an equal opportunity employer. Federal and State law prohibits discrimination in employment practices because of race, color, religion, sex, age between 40 and 70, national origin or disability. The information requested on this application is in no way designated for the purpose of limiting or excluding any applicant’s consideration for employment on the basis of the above. We appreciate your interest in employment at Hospice of Randolph County. If, due to a disability, you require help in order to complete this application, please let us know what accommodation you require by calling us at (336) 672-9300.

I certify that the facts stated on this application are true and complete to the best of my knowledge, and I hereby grant Hospice of Randolph County permission to verify all such information and I understand that any false statement, misrepresentation or omission of facts on this application may result in rejection of the application for further employment consideration or my immediate dismissal if discovered subsequent to my employment. I further agree that Hospice of Randolph County, Incorporated shall not be liable in any respect if my employment is terminated because of any false statement, misrepresentation or omission of facts made by me in connection to this application.

I understand that the information in this application will be checked and previous employers will be contacted for the purpose of verifying the information contained herein. I hereby grant Hospice of Randolph County, Incorporated permission to check my references and to verify the information contained in my application. Further, I authorize my former employers, personal references and others to give my information concerning me requested by Hospice of Randolph County, Incorporated, whether or not it is in their records, and I hereby release them and their companies from any liability whatsoever.

If offered employment by Hospice of Randolph County, I understand and agree to submit to a medical examination and any future medical examination required by the organization. Part of this examination includes drug testing and I understand I must submit a sample of my urine and/or blood for chemical analysis to determine the presence of illegal or non-prescription drugs in my system. Further, I understand that the presence of any illegal drug will result in denial of employment with Hospice of Randolph County, Incorporated.

I understand that this application for employment in no way obligates Hospice of Randolph County, Incorporated to employ me. However, should I be employed, I agree to comply with all guidelines, rules and regulations established by the Employer. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without previous notice to me. Background check will include Criminal History.