Please complete all sections of this application. Incomplete applications may not be considered.
Please read and complete this application in its entirety. Applicants who have not fully completed the application may not be considered for employment.
List supervision history starting with the most recent employer where you provided MH/DD/SA services.
List employment history starting with your most recent employer.
Please list clinical and educational references with whom you have had significant contact.
Special needs: for example “cannot work first Monday of every month”. You may provide additional details in an attachment if needed.
Please answer the statements below if applicable.
Please read the following statement carefully and indicate that you understand and agree. (Legal language should be reviewed and approved by GCSS.)
By submitting this application, I understand that:
I acknowledge that I have read and understand the above statements and that I have not intentionally misrepresented or omitted any facts on this application. I affirm that the information I have provided is true and complete to the best of my knowledge.
GCSS is an equal opportunity employer. We do not tolerate discrimination or harassment on the basis of race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, or other protected characteristics. A background check may be required for all applicants.
In connection with my application for employment (or, if applicable, for contract or residency), I understand that GCSS may obtain consumer reports or investigative consumer reports from a third-party agency. These reports may include criminal history, driving record, education and employment verification, licensing, and other information relevant to my suitability for employment.
I authorize GCSS and any consumer reporting agency engaged by GCSS to obtain, use, and share such reports for employment purposes, subject to applicable law. I understand that I have the right to request information about the nature and scope of any investigative consumer report and to dispute incomplete or inaccurate information.
Please print the following information:
As a condition of my consideration for employment (or continued employment) with GCSS, I understand that the agency may contact former employers, references, schools, licensing boards, and other sources to verify employment history, education, certifications, and other job-related information.
I authorize GCSS to obtain such information and I release GCSS, its representatives, and any person or organization providing information from liability related to the exchange of this information, to the extent permitted by law.
What you will need to be considered for employment may include:
If you are hired, you may also be asked to provide a voided check for direct deposit.
GCSS requires direct-care employees to complete an annual physical examination with a licensed provider. This helps ensure that staff are physically able to perform the essential functions of their positions and promotes a safe environment for the individuals we support.
Employees whose duties involve direct care are expected to maintain the physical and emotional capacity to meet the needs of individuals served. Failure to complete required physical examinations or to meet essential physical requirements may affect continued employment or assignment to certain duties.
GCSS may assist employees with scheduling physical exams or provide a list of community providers for this purpose. New staff are typically required to complete a physical exam within a specified time frame from their hire date, consistent with agency policy.
By acknowledging this policy below, I understand that maintaining compliance with personnel requirements, including physical examinations and related documentation, is a condition of my employment in a direct-care role at GCSS.
Uploaded files should follow GCSS file-size limits. Accepted formats typically include PDF, JPG, PNG, or GIF.
