Step 1 of 7 14% Apply Now Join Our Team All positions are for contractor status only. All applicants must have successful completion of background screening specific positions may require drug screening as requested. Your Name(Required) First Name Middle Name Last Name Your Email Address(Required) Enter Email Confirm Email Your Phone(Required)Date of Birth(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code This Company is an equal employment / contractor opportunity company that adheres to a policy of making employment/contractor decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for a contractual relationship with this Company depends solely on your qualifications. Position You're Applying ForPosition You're Applying For(Required) RN Hospice RN Home Health LPN/LVN Hospice LPN/LVN Home Health Auditor Salary DesiredDate Available to Start(Required) MM slash DD slash YYYY Hours You Are Available for WorkPlease tell us what hours you are available for work each day of the week.MondayTuesdayWednesdayThursdayFriday Add RemoveAre you interested in Hospice In-Patient?Are you interested in Hospice In-Patient?Yes, Day ShiftYes, Night ShiftNo, I am not interested in Hospice In-Patient AssignmentsAre you comfortable with Pediatric Pts? Yes No List the Geographical Area(s) You Can Cover: Education/TrainingHigh School(Required)Please list your education/trainingType of SchoolName of SchoolLocationYears CompletedDegree Earned Add RemoveCollege(Required)Please list your education/trainingType of SchoolName of SchoolLocationYears CompletedDegree Earned Add RemoveTrade SchoolPlease list your education/trainingType of SchoolName of SchoolLocationYears CompletedDegree Earned Add RemoveOtherPlease list your education/trainingType of SchoolName of SchoolLocationYears CompletedDegree Earned Add Remove Special RequirementsDo you have a current TB Screening?(Required) Yes No Do you have a current CPR card?(Required) Yes No Current Professional License / State:Specialty Certification(s): Most Recent Hospice Positions HeldYou can upload your complete resume on the last page of this form.CompanyJob TitleEmployment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Starting SalaryFinal SalarySupervisor First Last Supervisor Contact InfoJob ResponsibilitiesReason for LeavingMay we contact this employer? Yes No Position / JobCompanyJob TitleEmployment Start Date MM slash DD slash YYYY Employment End Date MM slash DD slash YYYY Starting SalaryFinal SalarySupervisor First Last Supervisor Contact InfoJob ResponsibilitiesReason for LeavingMay we contact this employer? Yes No Professional ReferencesPlease provide at least 3 professional references.References(Required)NameTitle / CompanyEmailPhoneYears Known Add RemoveReferences(Required)NameTitle / CompanyEmailPhoneYears Known Add RemoveReferences(Required)NameTitle / CompanyEmailPhoneYears Known Add Remove More About YouPlease provide any information you feel is important for us to know when considering your applicationUpload Your ResumeUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB.Terms and Conditions(Required)In exchange for the consideration of my independent contractor application by The Amity Group, Inc (hereinafter called “the Company”), I agree that: The acceptance of this contractor application by the Company in no way constitutes a contractual agreement between the contractor and the Company. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for the Company refuse my contracted services at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references and others, and hereby release the Company from any liability as a result of such contact. I also understand that (1) the Company has a drug and alcohol policy that provides for pre-contractual testing, as well as random testing at any time should I enter into a contractual relationship with the Company; (2) consent to and compliance with the drug and alcohol policy is a condition of my continued contractual relationship with the Company; and (3) continued contractual relationship with the Company is based on the successful passing of testing under such policy. I further understand that a continued contractual relationship may be based on the successful passing of service-related physical examinations. I understand that, in connection with the routine processing of this contractor application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, criminal background, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that any relationship with the Company is strictly that of an Independent Contractor and in no way constitutes an employee-employor relationship and all assignments are offered on an as needed basis only with no guarantee of hours/days worked and that as an independent contractor I am not entitled to receive any benefits from the Company, including, but not limited to healthcare, vacation/paid time off, workers' compensation, unemployment, travel expenses or holiday pay. I agree to the terms and conditions.CommentsThis field is for validation purposes and should be left unchanged.
