Apply Online

Personal Information

Eligibility Questions

1. Do you have any relatives employed by this company? Select Yes No
   If so, employee’s name(s):
2. How were you referred to Compass Memorial Healthcare?
3. Have you ever been employed by this company? Select Yes No
   If so, please state when, what position, and under what name:
4. Have you ever been convicted of a felony? Select Yes No
   If yes, explain: (NOTE: No applicant will be denied employment solely on the grounds of a conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
5. To be considered “qualified” under the Americans with Disabilities Act; an applicant must be able to perform the essential functions of a job with or without a reasonable accommodation. Can you perform the essential functions of the position for which you applied, with or without an accommodation by this company? Select Yes No
   If you answered no, please identify what job functions you cannot perform, with or without an accommodation by this company.
6. Are you either a citizen of the United States or a legal alien who has the right to work in the United States? You will be required to produce proof of your right to work following a conditional offer of employment. Select Yes No

Employment Objectives

Professional Licences and Certifications

1. Type

   Organization or State Issued

   Date Issued

   Number

   Verification
2. Type

   Organization or State Issued

   Date Issued

   Number

   Verification
3. Type

   Organization or State Issued

   Date Issued

   Number

   Verification

Applicant’s Authorization to Release Information

Please select yes or no for each item, fill in the requested information, and sign the form.

As an applicant for a position with COMPASS MEMORIAL HEALTHCARE, I authorize all past employers and educational institutions to release information about my work history and education for use in determining my qualifications for this purpose.

Please release or verify the items indicated:

1. All Information Requested Select Yes No

Past Employers

1. Salary History Select Yes No
2. Dates of Employment Select Yes No
3. Positions Held Select Yes No
4. Supervisors (Name of) Select Yes No
5. Responsibilities and Duties Performed Select Yes No
6. Reasons for Leaving Select Yes No
7. Eligibility for Rehire Select Yes No
8. Attendance Record for Last year of Employment Select Yes No

Educational Institutions