Job Application Legal Name(Required) First Last Preferred Name First Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone(Required)Email(Required) What Positions are you Interested in?(Required) Caregiver/Medtech/CNA LPN/RN Cook/Prep Cook Dining Room Assistant Housekeeping/Laundry Office Support Administration Activities Maintenance Select AllWhat locations are you interested in?(Required) Boise – Englefield Boise / Eagle – State Street Boise / Eagle – State Street MC Caldwell Chubbuck Fruitland Meridian – Fairview Lakes Meridian MC Nampa Twin Falls Twin Falls MC PRN – Multiple Locations Select AllWhat certifications do you have? (Check all that apply)(Required) CPR/1st Aide CNA License RCA License Medication Administration LPN/RN License None Select AllHow many hours a week are you available?(Required) Full time (30+ hours weekly) Part time (30 or fewer hours weekly) On-Call Select AllWhat shift(s) are you available for? (Care Staff / Medtechs Only) Day Shift (6:00am – 2:00pm) Swing Shift (2:00pm – 10:00pm) Night Shift (10:00pm – 6:00am) Select AllAre you over 18 years of age?(Required) Yes No Have you ever been charged or convicted of a felony?(Required) Yes No Felony Conviction Date(Required) MM slash DD slash YYYY Felony Type and Details(Required)Any Drug or Alcohol Related Offenses?(Required) Yes No Please state the details of the Drug or Alcohol related offense or conviction(Required)Any Sexual Harassment related offenses?(Required) Yes No Please state the details of the Sexual Harassment related offense(s)(Required)Any Physical or Mental abuse related offense?(Required) Yes No Please state the details of the Physical or Mental abuse related offense(s).(Required)Any Theft related offense?(Required) Yes No Please state the details of the Theft related offense.(Required)Are you aware of any outstanding warrants?(Required) Yes No Please state the details of any outstanding warrants.(Required)Are you now or have been on probation or parole?(Required) Yes No Please State the details of your probation or parole.(Required)Have you been charged with any other felonies not listed?(Required) Yes No Please state the details of any other felonies not listed?(Required)Have you had any Driving Infractions?(Required) Yes No Please state the details of your Driving Infractions.(Required)Are you able to perform all job requirements?(Required)Ex: lifting, pushing and pulling objects 30 lbs or greater, standing extended periods, frequent walking Yes No How much relevant experience do you have for the position you are applying for?(Required) 0-6 months 6-12 months 1-2 years 2+ years 5+ years 10+ years Job HistoryEmployer 1Not Applicable – Job 1 Not Applicable Please only check this box if you have no job prior job history.Employer Name (1)(Required)Employer Phone(Required)Employment Started(Required) MM slash DD slash YYYY Employment Ended(Required) MM slash DD slash YYYY Salary / Wages(Required)Supervisor Name(Required)Position Held(Required)Reason for Leaving(Required)Company Address(Required)Employer 2Not Applicable – Job 2 Not Applicable Please only check this box if your employment history consists of just one job.Employer Name (2)(Required)Employer Phone(Required)Employment Started(Required) MM slash DD slash YYYY Employment Ended(Required) MM slash DD slash YYYY Salary / Wages(Required)Supervisor Name(Required)Position Held(Required)Reason for Leaving(Required)Company Address(Required)Employer 3Employer Name (3)Employer PhoneEmployment Started MM slash DD slash YYYY Employment Ended MM slash DD slash YYYY Salary / WagesSupervisor NamePosition HeldReason for LeavingCompany AddressWhat other skills and qualities do you have that would make you an ideal candidate for this position?Have you ever worked at a Grace Community before?(Required) Yes No Which Grace Community did you previously work at?(Required) Boise – Englefield Boise / Eagle – State Street Boise / Eagle – State Street MC Caldwell Chubbuck Meridian – Fairview Lakes Meridian MC Nampa Twin Falls Twin Falls MC Do you know anyone who works at Grace?(Required) Yes No Please list the names of the people you know.When are you available to start training?(Required) MM slash DD slash YYYY How soon are you available for an interview?(Required) MM slash DD slash YYYY Preferred contact method(Required) Phone Text (SMS) Email Please attach your resume, cover letter or any other necessary documents Drop files here or Select files Max. file size: 256 MB. Section 10: Application Disclaimer(Required) Important – Please sign and readThe facts set forth in my application for employment are true and complete. I understand that if employed and false statement(s) are found on my application they may result in my dismissal. I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employee me. I understand and agree that my employment is at-will and can be terminated with or without notice, at any time, for any reason, or no reason. I understand and agree that Grace Assisted Living is a Drug Free environment. I fully understand that all employees are subject to random drug testing or for reasonable suspicion during employment. I fully understand and agree that Grace Assisted Living will complete two types of background checks as required by State law and the Department of Health and Welfare. a) A State only background check completed by Idaho State Police, paid for by Grace Assisted Living. b) Federal Finger Prints as per the Department of Health and Welfare. This background check is the financial responsibility of the employee. The employee has the option of either paying for this background check up front or Grace will pay for it thus resulting in a payroll deduction for the cost. The current cost (subject to change) is $65.00. If you have a current finger print report on file that is transferable to Grace Assisted Living there is no charge as long as it is within the last 3 years. As an equal opportunity employer this company’s policy, as well as Federal and State Law, prohibits discrimination in employment based on race, color, religion, sex, national origin, physical handicap, or age with respect to individuals who are at least 18 years of age. As part of this application for employment, I hereby authorize the company to investigate my references and to make an independent investigation on my character, conduct and employment records. For roles that require use of company vehicles, I hereby authorize Grace to complete a driving record check prior to initiation of employment. I further agree that failure to reveal any prior employer, or the giving of false or misleading information by me will be grounds for termination of my employment. I agree to the Application Disclaimer AboveDate MM slash DD slash YYYY CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
