Application

First Name *

Last Name *

Address *

City *

State

Zip *

Preferred Phone

Alt Phone

Emergency Contact

Emergency Contact Phone

Jobs Applied For

Type of Employment

Full-time

Part-time

Seasonal

What Position

Developmental Technician

Developmental Specialist

Community-Based Support Technician

Behavior Interventionist

Clinical Supervisor

Other Position (e.g. Intern)

Location you are willing to work

Meridian Adults

Nampa Adults

Meridian Children

Nampa Children

Current Certifications

First Aid

CPR

Habilitative Support

Behavior Interventionist

Assist w/Meds or SAMS Certification

Work hours for GSDC employees are based on participant's needs and adjusted at times, which may require changes in schedules and hours.
Please indicate the days and hours you are available to work

Days

Mon

Tues

Wed

Thurs

Fri

Sat

Hours

8-4

9-3

10-6

3-6

Anytime

Upon employment, fingerprinting and a criminal background check will be required in accordance with Health and Welfare's regulations.

How did you hear of this opening? *

If hired when could you start? *

Have you worked for GSDC before? *

Yes

If yes when?

List any friends or relatives who have worked for GSDC:

Do you have reliable transportation? *

Yes

Are you willing to provide GSDC and our insurance carrier with a copy of your Motor Vehicle Record? *

Yes

If hired, is there any reason why you would not be able to preform the functions of this job with reasonable accommodations (i.e.,lifting)? *

Yes

If yes please describe

Record Of Education

Name, City/State of School Attended

High *

City *

State

Start Date *

End Date *

Diploma *

GED *

College

City

State

Start Date

End Date

Graduated

Degree

Major/Minor

Other

City

State

Start Date

End Date

Graduated

Degree

Major/Minor

Honors, Scholarships, Military Service, or other special training received

Professional References

Name and Occupation

City and State

Phone

Name and Occupation

City and State

Phone

Name and Occupation

City and State

Phone

Employment History (Most Current)

Name of Business

City

State

From Date

To Date

Salary

Supervisor

Phone

Can we contact?

Yes

Job Title/Duties

Reason for Leaving

Name of Business

City

State

From Date

To Date

Salary

Supervisor

Phone

Can we contact?

Yes

Job Title/Duties

Reason for Leaving

Name of Business

City

State

From Date

To Date

Salary

Supervisor

Phone

Can we contact?

Yes

Job Title/Duties

Reason for Leaving

The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion or national origin. Public Law 90-202 prohibits discrimination because of age. Gem State Developmental Center (GSDC) does not discriminate because of handicapping conditions. The laws of some states prohibit some or all of the above mentioned types of discrimination.

I authorize all listed references, schools. and employers to answer all questions or release any information regarding my employment or educational experiences with them. I release them from any liability and hold them harmless from any claim for releasing any information within their knowledge and/or records. I further authorize Gem State Development Center (GSDC) to release to any person, firm, or organization with whom I may seek employment, any truthful information concerning my work experience with GSDC. I release and hold GSDC harmless from any claim for releasing any truthful information within their knowledge and/or records.

A resume may be submitted along wtih your completed application and can remain on file with GSDC for one year for future employment opportunities.

If hired, your employment with GSDC will be "at will" and for an unspecified term. Employment "at will" means that the employee or GSDC has the right to terminate the employment at any time, with or without cause or advanced notice.

All of the information provided in this application and any interview with GSDC is true and correct. I understand that if employed, misrepresentation or omissions are grounds for immediate termination. I also agree to abide by GSDC's rules and regulations.

I have read the above statements, have had an opportunity to have my questions about its content and intent answered and understand its terms.

Signature *

Signed Date *

* Required

You will receive a "Thanks for submitting your application" message if your application was successfully submitted. If you don't see this message then please correct any errors and resubmit.