• Gateways to Better Living, Inc.

    APPLICATION FOR EMPLOYMENT

  • We are an equal opportunity employer, dedicated to a policy of employment without regard to race, creed, color, age, sex, religion, national origin or disability. Applicants may request reasonable accommodation in the application/interview process.

  • Current Date / Time
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    2 digit month, 2 digit day, 4 digit year :

  • Referral Source*

  • Please list all of the state(s) you have lived within the past 5 years:*
  • Do you have a valid Ohio driver's license?*
  • Has your driver's license been suspended or revoked within the last three (3) years?*
  • Do you have an active automobile insurance policy?*
  • Have you ever had your auto insurance rejected, canceled, or been placed in a high-risk insurance program?*
  • Have you been involved in any motor vehicle accident, either at fault or not at fault.*
  • If involved in a motor vehicle accident, then when?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Have you been convicted of any traffic convictions in the last three (3) years?*
  • If you have traffic convictions, please list:
  • Have you ever been convicted of a crime (felony or dmisdemeanor) including but not limited to sex related or child abuse/molestation offenses?*
  • Have you ever been dismissed from or asked to resign from any employment position?
  • Have you ever been disciplined by an employer for abuse or neglect of a patient or client?
  • This position will require lifting and physically assisting non-ambulatory residents. Are you able to perform these job tasks?*

  • Work Preferences

    Gateways to Better Living, Inc. Employment Application
  • Position Desired (If requesting more than one, list first three choices in order of preference):*

  • Direct Care: Please indicate shift preference in order of preference 1,2,3)*
    Rows
  • Status*
  • Are you available to work overtime, as needed?*
  • Are you available to work weekends, as needed?*

  • General Information

  • Have you ever been employed here before?*
  • If employed here before, when?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Have you filled out an application here before?*
  • If filled out application before, when?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you legally permitted to work in the United States?*

  • Proof of U.S. citizenship or immigration will be required upon employment

  • Are any of your relatives, including your spouse, currently employed by Gateways?
  • Are you currently employed?*
  • If employed, may we contact your current employer?*

  • Educational Data

  • List all schools you have attended:*

  • Employment History

  • List all previous employment for the last ten (10) years in chronological order - last position or current employer first - including U.S. Military, if applicable. DO NOT OMIT ANY. *
  • List three people not related to you and whom we can contact for a professional reference. (preferably supervisors or people you have worked with)*

  • Gateways to Better Living, Inc.

    Applicant's Statement and Agreement

  • Please read the following carefully before signing this application for employment.

    1. I authorize Gateways to Better Living, Inc. to verify any information I have provided and I further authorize any of the name schools, companies or people listed to provide any information about me contained in their records and release them from liability for such disclosure.

    2. My signature below hereby authorizes disclosure of information to Gateways to Better Living, Inc. and releases Gateways to Better Living, Inc., its officers and employees from liability for such disclosure.

    3. I understand and agree that any misrepresentations, falsifications, or omissions by me in this application may be sufficient cause of cancellation of the application and/or seperation from Gateways to Better Living, Inc. if I become employed.

    4. If employed, I understand that my employment does not constitute a contract of employment. I understand that I have the right to terminate my employment at any time and that the Agency retains the same right.

    5. I agree that Gateways to Better Living, Inc. may require of me a health assessment and/or drug and alcohol screening in connection with an employment offer or while employed. I understand that if I do not pass the health assessment or I test positive for drugs or alcohol, my employment with Gateways to Better Living, Inc. may be terminated.

    6. I understand that, if employed, I am required to provide documents establishing my identity and eligibility to work in the United States.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: