EMPLOYMENT FORM
CALL US: 509-624-6009

EMPLOYMENT FORM

IF YOU ARE INTERESTED IN JOINING OUR TEAM PLEASE FILL OUT THIS FORM AND SUBMIT

GSS EMPLOYMENT


Name:*
E-mail:*
Phone:*
-
Are you authorized to work in the United States? *
Are you 18 years of age or older? *
Do you have a High School diploma or GED? *
Do you have a valid drivers license?*
Do you currently reside in Washington State? *
How long have you resided at your current address? *
How long have you resided in Washington State? *
Do you have a reliable vehicle? *
Do you have proof of insurance for your vehicle? *

The State of Washington has regulations that require a criminal, employment, and personal background check on all new employees. The next 2 questions below are directly from the State of Washington Background Check Application.

Have you ever been arrested or received a citation (including a DUI or DWI)*? *

*This includes any prior or current charges, arrests, convictions, Child or Adult Protection Action/Investigations, or any current investigations (even if sealed, dismissed, dropped, withheld judgement, or were a juvenile at the time)?

If yes, please explain:
Are you currently under investigation for a crime awaiting judgement? *
If yes, explain:
Please list any Training, Certifications you have documentation for?
Please describe your experience, if any, working with Adults and/or Children for care, special needs, or disabilities:
Are you comfortable with personal care? Such as bathing, cleaning, assisting clients? *
Are you looking for full time, or part time work?
What days and times of the week are you available to work? *
What days and times, if any, are you unable to work?
Please list 2 professional references with phone numbers: *
Please list 2 personal references, with phone numbers:*
Were you recommended to us by someone? If so, please list that person’s name:
Upload a File or Resume:
I hereby declare that the details provided above are true and correct to the best of my knowledge and I understand it is my responsibility to inform Grace Support Services of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. I hereby authorize sharing of the information with Grace Support Services solely for the purpose of obtaining employment, which will include a background check as required by the State of Washington.*
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Contact INFO

509-624-6009

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