Job Application

We appreciate your interest in the E. John Gavras Center. The E. John Gavras Center offers equal opportunities to all persons without regard to race, color, religion, age, sex, disability, national origin, ancestry, citizenship, military or veteran status, marital status, sexual orientation, domestic violence, victim status, predisposing genetic characteristics or genetic information, or any other status protected by law. Applicants who require reasonable accommodations during the application process may contact Danielle Wright.

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If under the age of 18 years of age, do you have a work permit?

Are you legally eligible for employment in the United States?

Position(s) Applying For

Date You Can Start?

YYYY

Have you ever been employed by the E. John Gavras Center before?

If yes, when?

Reason for leaving?

Are there any pending requests or convictions of a misdemeanor or felony including but not limited to a health care related crimes or larceny?

Have you even been convicted of a misdemeanor or felony of any nature?

If you answered yes, please give date, jurisdiction, charge and disposition

Do you have a valid New York State driver’s license?

Have you been convicted of any moving violation within the last three years, DWI convictions, or any other occurrences involving harm to persons or property while driving?

If yes, please explain

By checking this box I am indicating that I will send an up-to-date resume to dmw@gavrascenter.com and will not be completing the employment history section.

Name of employer #1

Job Title

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates Employed

Supervisor

Briefly describe your job duties and work experience:

Reason for leaving:

Name of Employer #2

Job Title

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dates Employed

Supervisor

Briefly describe your job duties and work experience:

Reason for leaving:

May we contact your present employer at this time?

I have provided truthful and complete responses to all inquiries in the application and authorize the E. John Gavras Center to investigate all statements contained in the application. I understand that the discovery of any falsifications or omission constitutes a ground for immediate dismissal or refusal to hire. If employed, I will abide by the Company’s rules and regulations, which I understand are subject to change by the Company.