Knox County Health Department

GoHire Employment Application:(Knox County Health Department)
Personal Information:
Full Name*

First NameMiddle NameLast Name
Last 4 digits of your Social Security number:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Are You a U.S. Citizen?

YesNo
Do You Possess a Valid Drivers License?

YesNo
Have You had a Valid Drivers License for at Least 3 Years?

YesNo
State of Issue:
Have you ever been discharged or asked to resign from a position?

YesNo
If Yes, Please Explain:
Have you ever been the subject of a PREA investigation? ( Prison Rape Elimination Act)*

YesNo
If Yes, Please Explain:
Employment Desired:
Position Applying For:
Date You Can Start

MonthDayYear
Salary Desired
Have You Ever Worked For One Of Our Partners Before?

GoHireAdantaKentucky River Community Care, Inc.Presbyterian Child Welfare AgencyKentucky River District Health DepartmentClark County Health DepartmentOther
Please Specify:
Have You Ever Worked For GoHire Before?

YesNo
Have You Applied Here Before?

YesNo
I Will Accept Part Time Employment:

YesNo
I Will Accept Temporary Employment:

YesNo
I Have Immediate Family Members Who Work for GoHire?

YesNo
Name of Family Members:
Education:
High School
Name of High School Attended
Number of Years Attended
Graduated?

YesNo
Year Graduated:
College
Name of College/University Attended
Number of Years Attended
Graduated?

YesNo
Year Graduated:
Degree Earned:

Associates DegreeBachelors Degree
Area of Study/Degree
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

YesNo
Year Graduated:
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

YesNo
Year Graduated:
Area of Study/Degree
Skills/Qualifications:
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
License or Certifications
List any relevant certifications or qualifications
Military Service:
**Military Service Information used to complete mandatory Federal VETS 100 & VETS 100A reports. If employment offer is made, a copy of discharge document must be presented prior to the start of employment.
Branch Name (None if not applicable):*
Years of Service
Vietnam Era Veteran?

YesNo
Armed Forces Service Medal?
Other Veteran?
Discharge Date:

MonthDayYear
Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position
Reason for Leaving?
Description of Duties:
Start Date*

MonthDayYear
May We Contact?

YesNo
Previous Employment:
Previous Employer*
Name of Previous Employer
Position
Description of Duties:
Reason for Leaving?
Start Date*

MonthDayYear
End Date*

MonthDayYear
Previous Employer
Name of Previous Employer
Position
Description of Duties:
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
References:
Reference 1*
Name of Reference
Relationship*
Years Acquainted
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Email
Reference 2*
Name of Reference
Relationship*
Years Acquainted
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Email
Reference 3*
Name of Reference
Relationship*
Years Acquainted
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Email
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

Cancelof
Resume

Upload a File

Cancelof
Affirmative Action Program Applicant Information Form:
GoHire, Employment and Development, Inc. is an Equal Opportunity Employer. As required by law, we must record and report certain information to be made a part of our Affirmative Action Program.

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, sexual orientation, victim status, pregnancy, disability, veteran status, or any other characteristic protected under local, state of federal law. WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as a veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Corporate Office; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Please complete the information requested below. Thank you for your cooperation.
Gender:
Race Ethnicity:

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.
Send Application:
I certify that all answers to the questions in this application are true. Falsification or failure to answer all questions is sufficient grounds for rejection of this application. I further understand that Go-Hire Employment and Development, Inc. employs at will which means that either the employee or the employer may terminate with or without cause not prohibited by law. I understand that the President and the Board Chair are the only officers of this agency who are authorized to enter into employment contracts and may do so only in writing. I authorize Go-Hire to do a thorough investigation of my past employment, education, and activities, which includes but not limited to fingerprinting and drug testing for purposes of obtaining information regarding past criminal convictions and I release from all liability all persons, companies and corporation supplying that information. I release and indemnify Go-Hire against any liability that might result from making such an investigation. I realize that nothing in this application is intended to constitute a contract, in whole or in part. I understand this application will be shared via electronic means with Go-Hire contractors seeking to fill position vacancies. By submitting this application I agree to the release and sharing of all information contained herein.
I Have Read and Understood the Employment Policy.
Signature

Clear
Where Did You Hear About GoHire?

Newspaper AdEmployee ReferralRecruiterTech School/College PlacementTemporary ServiceTV AdEmployment Agency Office
Other:
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GoHire Employment Application:(Knox County Health Department)

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Military Service:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

Affirmative Action Program Applicant Information Form:

Send Application: