Careers Employment ApplicationInterested in working at Glenhaven Adult Family Home? Please complete all 3 steps below & we will reach out to you shortly to schedule an interview! Step 1: Please open, fill out AND submit the application. Application Careers Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Certifications * RN LPN Certified Home Care Aide Nursing Assistant Registered Nursing Assistant Certified Nurse Delegation None of the above Additional Credentials * Mental Health Alzheimer’s & Dementia Specialty Training CPR/First Aid Orientation and Safety Washington State Food Worker Card Nurse Delegation Nurse Delegation with Focus on Diabetes None of the above Please tell us a little about yourself? * Are you over 16 years of age? Yes No Are you legally eligible to work in the United States? * Yes No Expected Salary? Do you have reliable transportation? * Yes No Date Available to Start? * MM DD YYYY Are you interested in part-time or full time work? * Please select all days you are available to work. * Monday Tuesday Wednesday Thursday Friday Saturdays Sunday Our night shifts are awake shifts. If applying for a night shift, do you foresee any difficulty remaining awake and alert for the entire shift? * Yes No Please select all shifts you are available for work? * Days: 7am – 3pm Swings: 3pm – 11pm NOC: 11pm – 7am As Needed This position requires working some holidays and may require overtime, weekend work, and staying on shift until your relief arrives. Do you foresee any problems fulfilling these requirements? * If “Yes”, please explain. Yes No If “Yes”, please explain. How flexible are you to cover shifts and substitute for teammates, outside of your regular work schedule? * Highly Flexible Somewhat Flexible Rarely Flexible Never Flexible If you have any plans/appointments in the next three months that would conflict with your work schedule, please provide important information. Dates of conflicts Are you currently employed? * Yes No Employer/Company Name Please provide your most recent employment details: Dates Employed Employers Phone (###) ### #### Can we contact this employer? Yes No If "No" please provide employer reference you'd like us to contact. Company Name Supervisors Name Dates Employed Supervisors Phone Number Are you restricted from lifting specific weights? * Yes No Have you dealt with incontinence (both bowel and bladder) and used incontinence products on any of your previous jobs? * Yes No This job requires you to transfer residents from bed to wheelchair and from wheelchair to bed or toilet or chair. Do you have any physical limitations that would prohibit you from task? * If "Yes", please explain below. Yes No If "Yes", please explain. How would you describe your housekeeping skills (laundry, cleaning bathrooms, floors, etc.)? * How would you describe your skills in preparing meals/cooking? * What other skills/abilities do you have that pertain to this position? Please provide 2 references * How did you hear about this open position? * If "Other" please explain below. Facebook/Social Media Search Engine (i.e., Google, Bing, DuckDuckGo etc.) Job Boards (i.e., ZipRecruiter/Indeed/LinkedIn etc.) Referral/Friend/Family/Word of mouth Other If "Other" please explain. How did you hear about this position? Please complete all 3 steps.Thank you! Step 2: Click the following button to open the WA State DSHS Background Authorization Form. DSHS Form Step 3: Please fill out the Washington State DSHS Form completely & submit it. Thank you! We will contact you shortly to schedule an interview.
