Employment Application

Our staff is a unique team full of compassion, respect and integrity. If you desire to help HPCIC in fulfilling our mission of helping our patients and their families meet their end-of-life goals, we encourage you to complete our online employment application.

Should we determine that your qualifications and background align well with any opening that we may have, we will certainly be in contact with you. It is not necessary to place a phone call to the office.

Please remember that we do keep our applications on file for at least 12 months. Thank you for your interest in our organization.



Step 1

Personal Information

indicates a required field

Desired Contact Method

Are you over 18?

If no, can you provide required proof of your eligibility to work?

After employment, can you submit proof of your U. S. citizenship or immigration status?

Have you ever been convicted of any crime?

If Yes, please explain.

Conviction will not necessarily disqualify an applicant from employment.

Are you willing to submit to drug testing at the direction of Hospice & Palliative Care of Iredell County?

Step 2

Employment Desired

indicates a required field

How did you learn about Hospice & Palliative Care of Iredell County?

Type of Preferred Status

Have you ever applied for employment with us?

Type of Availability

Hospice & Palliative Care of Iredell County, 2347 Simonton Road, Statesville, NC 28625 is an equal opportunity employer and does not discriminate in its employment practices on the basis of race, color, veteran status, gender, age, creed, religion, disability, or national origin.

This application will be given every consideration; its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered.

Step 3

Education & Training

indicates a required field

High School

Did you graduate?

Business/Trade/Tech School

Did you graduate?


Did you graduate?

Graduate School

Did you graduate?

Describe any specialized training, skills, apprenticeships and extracurricular activities. Also indicate any foreign language(s) you can speak, read and/or write:

List membership in professional, trade, business or civic organizations and offices held (exclude those which may reveal your gender, race, religion, national origin, age, disability or other protected status):

Did you serve in the U. S. Armed Forces?

If Yes, describe any training received relevant to the position to which you are applying:

Step 4

Employment History

indicates a required field

Start with your present or most recent employer. Give accurate, complete information accounting for all periods of time including military service and any periods of unemployment. Please give month and year.


Employed From


Pay Rate



Employed From


Pay Rate



Employed From


Pay Rate


Step 5

Supplemental Employment Information

indicates a required field

If you ever worked in any of your previous positions under another name, please give that name(s)

Are you presently employed?

If Yes, may we contact your present employer?

Have you ever been fired, or asked to resign, from a job?

If Yes, please explain:

Are you related to any current employee, volunteer, or board member at Hospice & Palliative Care of Iredell County?

Step 6


Give three references listing name, address, phone number, and occupation. Do not list relatives or former employers.

Reference 1

Reference 2

Reference 3

Step 7

Affidavit & Release Authorization


  • I certify that my answers to the foregoing questions are true and correct without and consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application form, any inserts/attachments or during any interviews may be grounds for immediate dismissal.
  • I hereby authorize Hospice & Palliative Care of Iredell County to contact any company or individual it deems appropriate to investigate my employment history, character, and qualifications. I give my full and complete consent to their revealing any and all information they wish as a result of this investigation. In addition, I hereby waive my right to bring any cause of action against these individuals for defamation, invasion of privacy, or any other reason because of their statements.
  • I agree that, if I am employed, I will abide by all the rules and regulations of Hospice & Palliative Care of Iredell County. I will also adhere to the CORE VALUES of Hospice & Palliative Care of Iredell County.
  • I understand this application shall be considered active for a period of time not to exceed ninety (90) days. If I wish to be considered for employment beyond this time period, I should inquire whether applications are being accepted at that time.
  • HPCIC has/will soon mandate COVID vaccinations as a condition of employment. Exemptions are allowed for medical or religious reasons but must be documented and approved prior to employment.

Release Authorization


List States and Counties of residence other than that above, for the past seven years.

In consideration of my application, I authorize Hospice & Palliative Care of Iredell County, Inc, by and through QPI to verify all data given by me on application, related papers or oral interviews. I understand a thorough investigation may be conducted which may include but not be limited to criminal history, motor vehicle driving record, education verification, employment history, credit report and personal history. I hereby authorize employers, agencies, personal references and other persons with whom I am acquainted to answer all questions and release all information concerning my employment record, character, reputation, ability, education, military service, credit history and other applicable reports. Furthermore, I release all agencies, bureaus, employers, information service organizations, and individuals or companies named above from all liabilities of damages that might result from information provided in good faith. I state that the information provided by me on my application is accurate and I agree that if any information therein is found to be false at any time, my application may be discarded or my employment terminated. I understand that the information requested below regarding sex, race and date-of-birth are for the sole purpose of gathering the above information accurately and will not be used to discriminate against me in violation of the law.

I certify that all the information contained in my employment application is true to the best of my knowledge. I further understand that if I am given the opportunity to begin employment with Hospice & Palliative Care of Iredell County, prior to completion of my background investigation and it is determined that I gave false statements, or any omission of a material fact, I may be subject to immediate discharge.

Statesville Office

2347 Simonton Road
Statesville, NC 28625
Phone: 704-873-4719
Map & Directions

Mooresville Office

1325 Mecklenburg Highway
Mooresville, NC 28115
Phone: 704-663-0051
Map & Directions