GSC Employment Application

GSC Employment Application

If you have any questions or issues please contact Victoria at glorious.seniorcare@gmail.com
Personal Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Social Security Number (SSN)
Format: XXX-XX-XXXX
Gender*
Certified Nursing Assistant (CNA)Registered Nurse (RN)Licensed Practical Nurse (LPN)Home Health Aide (HHA)
Employment Type*

Employment Eligibility
Are you A U.S. Citizen?*
Are you legally authorized to work in the United States?*
Have you ever been employed by Glorious Senior Care LLC*
Position*
Start Date*

MonthDayYear
Date
End Date (Current Employees leave Blank)

MonthDayYear
Date
Have you been convicted of a felony or misdemeanor?*
A conviction will not automatically disqualify you from employment. Factors such as the nature of the offense, time elapsed, and relevance to the position will be considered.
Please provide the nature of the offense*
Date of Conviction*

MonthDayYear
Date
Jurisdiction*

Education

List your highest or most relevant level of education completed.
School name*
City, State*
Start Date*

MonthDayYear
Date
End Date (Currently enrolled students leave blank)

MonthDayYear
Date
Level of Education*
Field of Study*
Diploma/Degree Earned*
Did you Graduate?*
Licenses & Certifications
List all relevant licenses and certifications you hold.

References

Please provide up to two professional references who can speak to your work performance. Do not include family members. By providing this information, you authorize us to contact the listed references for employment verification purposes.
Name*

First NameLast Name
Company/Organization*
Relationship to You*
If Other, Specify
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Name*

First NameLast Name
Company/Organization*
Relationship to You*
If Other, Specify
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com

Background Check Disclosure and Authorization
In connection with your employment application and, if hired, during your employment, Glorious Senior Care LLC may obtain a consumer report and/or investigative consumer report for employment purposes.

These reports may include verification of:
1. Criminal history (where permitted by law)
2. Employment history
3. Education
4. Professional licenses or certifications
5. Driving record (if job-related)
6. Other information relevant to employment eligibility
Any report will be obtained in accordance with the Fair Credit Reporting Act (FCRA) and applicable state and local laws.
I authorize Glorious Senior Care LLC to obtain consumer reports and/or investigative consumer reports for employment purposes as described above.
Name*

First NameLast Name
Signature

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Date

MonthDayYear
Date
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Personal Information