NOT-FOR-PROFIT 181 E. Perry St., Tiffin, Ohio 44883 Phones: (419) 447-4040 or (800) 834-8100 FAX: (419) 447-4657 E-Mail: communityhospice@acctiffin.com http://www.communityhospicecare.com/

HOSPICE LINKS Home Mail Referrals for Care Criteria For Admission Bereavement Services Volunteer Opportunities Employment Opportunities Make A Donation Fundraising Activities Privacy Practices Feedback OTHER LINKS Seneca County Convention & Tourism Bureau Tiffin Chamber of Commerce Fostoria Chamber of Commerce Tiffin-Seneca United Way Fostoria United Way Tiffin-Seneca Public Library Kaubisch Memorial Public Library Bliss Memorial Public Library Mohawk Community Library Tiffin University Pfeiffer Library Seneca East Public Library Willard Memorial Library National Hospice and Palliative Care Organization A United Way Member Agency Community Hospice Care has earned the Joint Commission's Gold Seal of Approval *State Licensed *8th Hospice founded in Ohio

Employment Opportunities  Now accepting applications for: RNs Social Workers Home Health Aides - Part-time Office Personnel Please complete the on-line application below, or stop in our office at 181 E. Perry St., Tiffin, OH APPLICATION FOR EMPLOYMENT CONFIDENTIAL This institution does not discriminate in hiring of employment on the basis of race, color, religious creed, national origin, sex, or ancestry, or on the basis of age or physical or mental handicap unrelated to ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination. This application will be given every consideration, however its receipt does not imply that the applicant will be employed. PERSONAL INFORMATION: Date of Application:mm/dd/yyyy Date Available: mm/dd/yyyy Last Name: First Name: Middle Initial: Social Security Number: xxx-xx-xxxx Present Street Address: City: State: Zip Code: Phone Number: xxx-xxx-xxxx E-Mail Address: Professional License No.: Type:   If you cannot be reached at the above number, where may we contact you? Name Phone Number Reasons you are interested in hospice employment: Do you have any physical condition which may limit your ability to perform the particular job for which you are applying? If yes, describe such condition and explain how you can perform the job for which you are applying in spite of it Have you ever been convicted for a felony or any offense involving the use of drugs? YES NO EDUCATION: High School Name & Address: Course of Study: Year Completed: 1 2 3 4 Did you graduate? YES NO Diploma/Degree   College School Name & Address: Course of Study: Year Completed: 1 2 3 4 Did you graduate? YES NO Diploma/Degree   Other Education: Course of Study: Year Completed: 1 2 3 4 Did you graduate? YES NO Diploma/Degree If you received TRAINING in an area which you feel is relevant to the position(s) for which you are applying, please submit the following information (do not include training gained as part of your education as described above): Other Training: EMPLOYMENT HISTORY: 1. Name & Address of Company & Type of Business: From:mm/yyyy To: mm/yyyy Starting Weekly Salary: Endng Weekly Salary: Reason for Leaving: Name of Supervisor:   2. Name & Address of Company & Type of Business: From:mm/yyyy To: mm/yyyy Starting Weekly Salary: Endng Weekly Salary: Reason for Leaving: Name of Supervisor:    After submitting this application form, please send your resume, along with references to: Community Hospice Care 181 E. Perry St. Tiffin, OH 44883 or E-Mail to: communityhospice@acctiffin.com