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)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. CAPTCHADate MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged. Δ
