GREATER LIVING JOB and CONTRACTOR APPLICATION

JOB/CONTRACTOR APPLICATION

Greater Living Home Care is currently hiring RN's, LPN's, CNA's, and PCA's. To apply, please complete this application in its entirety.
Name*

First NameLast Name
What is your Date of Birth?*
What is your Social Security Number?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
Please enter a GMAIL EMAIL address. This will be needed to share important documents in Google Drive in the future.
Position Applying For*

RNLPNCNAPCAAdministrative PositionOther
Hourly Pay Expectation*
How many years of experience do you have in the selected position?*
How did you hear about this position?*

Indeed.comFacebookInstagramFlyerClient ReferralStaff Referral
If someone referred you for this position, please enter his or her name below.
Are you a U.S. Citizen or approved to work in the United States?*

YESNO
Do you have CPR certification that is less than 2 years old?*

YESNO
Do you have First Aid certification that is less than 2 years old?*

YESNO
Do you have NEGATIVE TB test results that are less than 1 year old old?*

YESNO
Do you have a CNA or PCA certification?*

YESNONot Applicable
Do you have an RN License?*

YESNONot Applicable
Do you have an LPN License?*

YESNONot Applicable
Have you ever been convicted of a misdemeanor?*

YESNO
If yes, please list your charge(s) and the date(s) of occurrence.
Have you ever been convicted of a felony?*

YESNO
If yes, please list your charge(s) and the date(s) of occurrence.
What are your days and hours of availability?*
What mode of transportation do you have?*

I have my own car.I rely on public transportation such as UBER or buses to get to work.I have a friend or family member who can take me to and from work.
How many miles from your home are you willing to travel for work?*
Have you ever applied to or worked for Greater Living Home Care before?*

YESNO
Do you have any friends, relatives, or acquaintances working for Greater Living Home Care?*

YESNO
If yes, state name and relationship
EDUCATION AND TRAINING

Please list any education or training you have below.
High School Name*
High School City and State*
High School Year Graduated*
#1 College/University Name
#1 College/University City and State
#1 College/University Years Attended
#1 College/University Degree Earned
#2 College/University Name
#2 College/University City and State
#2 College/University Years Attended
#2 College/University Degree Earned
Vocational School/ Specialized Training Name
Vocational School/ Specialized Training City and State
Vocational School/ Specialized Training Year Graduated
Vocational School/ Specialized Training Degree or Certificate Earned
Please list any other specialized training or skills you possess that you would like for us to know about below. (Ex: CPR, First Aid, BLS)*
WORK HISTORY

Please list the LAST 5 YEARS OF YOUR RELEVANT WORK EXPERIENCE. List in CHRONOLOGICAL ORDER!
Previous Employers

Be sure to cover THE LAST 5 YEARS up until PRESENT DAY! Please make sure that there are NO EMPLOYMENT DATE GAPS.
Employer #1 Name:*
Job Title:*
Supervisor Name:*
Employer Telephone:*
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates Employed:*
Enter the start and end dates. (Example: May 2021- August 2024)
Reason for Leaving:*
Employer #2 Name:*
Job Title:*
Supervisor Name:*
Employer Telephone:*
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates Employed:*
Enter the start and end dates. (Example: May 2021- August 2024)
Reason for Leaving:*
Employer #3 Name:
Job Title:
Supervisor Name:
Employer Telephone:
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates Employed:
Enter the start and end dates. (Example: May 2021- August 2024)
Reason for Leaving:
REFERENCES

Please provide 3 PROFESSIONAL references and 1 PERSONAL reference below.
PROFESSIONAL REFERENCE #1 Name:*

First NameLast Name
PROFESSIONAL REFERENCE #1 Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
PROFESSIONAL REFERENCE #2 Name:*

First NameLast Name
PROFESSIONAL REFERENCE #2 Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
PROFESSIONAL REFERENCE #3 Name:*

First NameLast Name
PROFESSIONAL REFERENCE #3 Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
PERSONAL REFERENCE #1 Name:*

First NameLast Name
PERSONAL REFERENCE #1 Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
EMERGENCY CONTACT
Emergency Contact Person Fill Name*

First NameLast Name
Relationship to Emergency Contact Person*

SpouseSiblingParentGrandparent
Emergency Contact Person's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Person's Email Address*
example@example.com
DIRECT DEPOSIT INFORMATION
Bank Name
Routing Number
Account Number
Voided Check (You may upload a voided check instead of entering the information above.)

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Upload Your Documents Below.
Resume*

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Front of Driver's License*

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Back of Driver's License*

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Front of Social Security Card*

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RN,LPN, PCA, CNA License, Certifications

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TB Test Results

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CPR/First Aid

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Selfie (Please upload a picture of yourself.)*

Cancelof
File Upload

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TB Test Results

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AT-WILL

The relationship between you and Greater Living Home Care is referred to as "at will." This means that you can be terminated at any time for any reason, with or without cause, with or without notice, by you or Greater Living Home Care. No representative of Greater Living Home Care has authority to enter into any agreement contrary to the foregoing "at will" relationship. You understand that your relationship is "at will," and that you acknowledge that no oral or written statements or representations regarding your position can alter your at-will employment status, except for a written statement signed by you and either our CEO. Greater Living Home Care is an equal opportunity company.
Signature:*
Date*

MonthDayYear
Date
Should be Empty:

JOB/CONTRACTOR APPLICATION

EDUCATION AND TRAINING

WORK HISTORY

Previous Employers

REFERENCES

EMERGENCY CONTACT

DIRECT DEPOSIT INFORMATION

Upload Your Documents Below.

AT-WILL