Online Job Application Form

Employment Application Form:

Note: All employment applications MUST be completed in full - Incomplete applications WILL NOT be considered.
G E 4 Me offers an equal opportunity for employment to all applicants without regard to race, ethnicity, age, sex, gender identity, color, citizenship, marital status, sexual orientation, religion, gender, national origin, disability, or veteran status. Should you require reasonable accommodation to complete this application, please inform us so that a reasonable accommodation can be made.
Applicant Information*

First NameMiddle NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Applied Position*
Part-Time/ Full-Time*
How did you learn about this position?*
Do you have any friends or relatives who work here?*

YesNo
If yes, please list here:
Eligibility & Availability:
Are you at least 18 years old?*

YesNo
If hired, are you able to submit proof that you are legally eligible for employment in the United States*

YesNo
If hired, are you able to perform the essential functions of this position with or without reasonable accommodations?**

YesNo
What limitation, if any, may impact your ability to preform the essential functions of this position?
List any skills or abilities that may be useful for the job you are seeking. Enter the number of years of experience and circle the number which corresponds to your ability for each particular skill. (1 represents poor ability, 5 represents exceptional ability)*
Are you willing to work any shift, including nights and weekends?*

YesNo
If no, please state shift of preference and any other limitations

Available days and shifts for work.*

	No Restrictions	8am-4pm	4pm-12am	12am-8am	Not Avaliable
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Earliest Possible Start Date*

MonthDayYear
Date
Are there any upcoming days/vacation that may affect your schedule?
Education & Training:
Name of High School or place where HS Diploma or GED received*
College/University name and address:
Did you receive a degree?

YesNo
If yes, Degree recieved?
Other training (graduate, technical, vocational):
Please indicate any current professional license or certifications that you hold:
Employment History

List your current or most recent employment first. Please list all jobs for the past 5-years (including school, self-employment, and military service) which you have held, please list and explain any gaps in employment.
1. Employee Name*
Phone Number*
Please enter a valid phone number.
Supervisor Name

First NameLast Name
Address*
Job Title and duties*
Reason for leaving*
Date of employment*

MonthDayYear
Date
May we contact?

YesNo
2. Employee Name
Phone Number
Please enter a valid phone number.
Supervisor Name

First NameLast Name
Address
Job Title and duties
Reason for leaving
Date of employment

MonthDayYear
Date
May we contact?

YesNo
3. Employee Name
Phone Number
Please enter a valid phone number.
Supervisor Name

First NameLast Name
Address
Job Title and duties
Reason for leaving
Date of employment

MonthDayYear
Date
May we contact?

YesNo
References:

Professional references can not be a relative.
Reference 1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Reference 2*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
We are committed to providing quality and ethical care to our patients, residents, and consumers. We are also committed to providing a safe environment for our patients, residents, consumers, and employees. Therefor; it is also the policy of our company to conduct a pre-employment drug screen. Once a conditional offer of employment has been made, we will run a background check on all employees. If your position requires that you drive a vehicle, we will also obtain a DMV clearance. Failing the background check shall be just cause to terminate your employment. If you fail the DMV clearance, and your position requires you to drive a vehicle, you may be terminated or experience a change in employment status
Upload Resume

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I certify that the information provided on this application is truthful and accurate. I understand that omitting information, or providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize G E 4 Me, LLC to contact former employers, educational organizations, and non-relative references regarding my employment, character, and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades.

I authorize those persons designated as references to fully and freely communicate information regarding my character, previous employment, and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Director, the employment relationship will be "At-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice.

Similarly, my employer will have the right. Moreover, no agent, representative, or employee of G E 4 Me, LLC Home, except in a specific written contract of employment signed on behalf of the organization by its Executive Director, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
Signature - To acknowledge you have read the information above*

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Date*

MonthDayYear
Date
Should be Empty:

Employment Application Form:

Eligibility & Availability:

Education & Training:

Employment History

References: