Good Shepherd Recovery House
Job Application
First Name:
Middle Name:
Last Name:
Gender:
Male
Female
Other
Veteran:
Veteran
Non-Veteran
Birth Date:
Home Address (Street Name and Number, City, State, Zip code):
Cell Phone:
Email Address:
Are you a U.S. Citizen:
Yes
No
Green Card or Visa
As an employee, are you willing to be drug tested weekly?:
Yes
No
Position you are applying for:
Available Start Date:
Employment Type Desired:
Full-Time
Part-Time
Seasonal/Temporary
Are you willing to work alternating weekends?:
Yes
No
Highest Education Level Completed:
Elementary School
Middle School
High School
Technical College
4-Year College
Graduate School
Can you read and write?:
Yes
No
Are you proficient with a computer and cell phone for data entry, text and phone calls:
Yes
No
Employment History (Employer Name, Year you began, Year you ended, Title of Job, Description of Job):
Volunteer History (Organization for whom you volunteered, Year began, Year ended, Position, Position Description):
Referrals: Enter the Name, Phone Number, Email Address and Relationship of 3 people for a character reference:
Certification:
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature:
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