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Application Form
Application Form
Kelly
Employment Form
"
*
" indicates required fields
Primary position
*
Choose One
Direct Support
Other
Are you seeking full-time or part-time employment?
*
Full-Time
Part-Time
How did you hear about us?
*
Choose One
Current Great River Homes Employee
Former Great River Homes Employee
Great River Homes Website
Great River Homes Board Member
Indeed
MinnesotaWorks.net
Facebook
Community Event
Community Posting
Newspaper Ad
Friend/Relative/Community Member
Radio
Other
Employee's Name
*
Board Member's Name
*
Friend/Relative/Community Member Name
*
You can add up to 3 names
PERSONAL INFORMATION
Name
*
First
Middle
Last
Address
*
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone Number
*
Email
*
Have you ever been employed with us before?
*
Yes
No
Do you have a valid drivers license?
*
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? (Proof required upon employment)
*
Yes
No
On what date would you be available to start?
*
MM slash DD slash YYYY
What time(s) would you be available to work on Sunday?
*
What time(s) would you be available to work on Monday?
*
What time(s) would you be available to work on Tuesday?
*
What time(s) would you be available to work on Wednesday?
*
What time(s) would you be available to work on Thursday?
*
What time(s) would you be available to work on Friday?
*
What time(s) would you be available to work on Saturday?
*
Would you consider working an overnight shift?
*
Yes
No
Note: Work Schedules Are Based Upon The Needs Of The Business And May Be Subject To Change On A Weekly Basis.
WORK HISTORY
Begin With Your Most Recent Employment (1) And Continue With Past Employment
Employment #1>
Employer
Address
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone Number
Job Title
Name & Title of Supervisor
Reason for Leaving
Employed From
(mm/yyyy)
Employed To
(mm/yyyy)
Work Performed
Employment #2>
Employer
Address
Street Address
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone Number
Job Title
Name & Title of Supervisor
Reason for Leaving
Employed From
(mm/yyyy)
Employed To
(mm/yyyy)
Work Performed
ATTENDANCE AND PUNCTUALITY INFORMATION
Consistent attendance and punctuality are essential requirements of every job with this business. Is there anything which would interfere with your regular attendance and punctuality if you are offered a job with this business?
Yes
No
EDUCATION
Education History - List High School and any post High School education. Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools
*
Click the + button on the far right to add additional high schools, colleges, universities, technical colleges, or trade schools
Type of School
Name and Address Of School
Highest Grade Or Year Completed
Received Diploma?
Add
Remove
Describe any specialized training, apprenticeship, skills, extra-curricular activities, or additional information for consideration.
*
PERSONAL OR BUSINESS REFERENCES
Please add 3 References
Reference 1
Click the + button on the far right to add additional references.
Name
Address
Phone Number
Add
Remove
NOTIFICATION AND AGREEMENT
The information that is provided in this application is accurate and complete. I certify that I have provided a true representation of my previous job history, personal qualifications, and other relevant information. I authorize representatives of Great River Homes, Inc. to investigate information about my application, including references from previous employment or personal references noted.
I understand that Great River Homes, Inc. will complete a criminal background check, and I authorize the agency to make this inquiry. I further understand that I may be disqualified from employment with the organization if I have a substantiated record of criminal activity that warrants disqualification according to law.
This application for employment is considered active for a period of 45 days. If the applicant wishes to be considered for employment with Great River Homes, Inc. beyond that period of time, the applicant should request that their application continue to be considered.
Great River Homes, Inc. has an "at will" relationship with its employees. This means that an employee is not required to work for the agency for any set period of time, and that Great River Homes, Inc. is not required to employ an individual for any set period of time. Great River Homes, Inc. may discharge an employee at any time with or without cause.
I understand that by accepting employment with Great River Homes, Inc. that I am required to take direction from my supervisors and abide by the policies, procedures, and regulations of the Agency. I also agree to participate in all required orientation and training which is provided to me by Great River homes, Inc.
I understand that by presenting false or misleading information on my application or during the application process, the management of Great River Homes, Inc. can take immediate action to disqualify my application or terminate my employment.
I have read and agree to these statements
*
Yes
I acknowledge that all available positions for Great River Homes, Inc. are located in southeastern Minnesota only.
*
Yes
Resume
If you have an electronic version (Word, PDF, etc.) of your resume, you may attach it here.
Max. file size: 50 MB.
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