Careers

Join our dynamic team at EMINENT Healthcare, where your skills can make a difference! We are looking for passionate individuals dedicated to supporting those with developmental disabilities. Explore exciting career opportunities and help us create an inclusive community. You may fill out the form below to apply!

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Today's Date

Full Name *

Street Address *

City *

State

Zip Code *

Home Phone Number *

Cell Phone Number *

Email Address *

Position Applied For

Social Security Number

WHAT LICENSE AND CERTIFICATION DO YOU CURRENTLY HOLD?

1. Are you eligible to work in the United States?

• Yes
• No

2. Are you 18 years of age or older?

• Yes
• No

3. Are you currently employed at a company?

• Yes
• No

4. Have you ever been employed by DGH?

• Yes
• No

5. Do you have any relatives employed by this company DGH?

• Yes
• No

6. If you are applying for a position which involves driving on the job please answer the following: 1) Do you have a valid unexpired driver's license to drive a vehicle?

• Yes
• No

2) Do you have insurance coverage?

• Yes
• No

3) Has your license been revoked or suspended during the past 7 years?

• Yes
• No

7. How did you learn about this position?

• Job Bulletin
• Walk IN
• Website
• Referral
• Other

8. Have you ever been convicted of a crime?

• Yes
• No

If yes, provide specifics below

9. Are you willing to be tested for the illegal use of drugs prior to and during your employment?

• Yes
• No

10. What is your availability for work?

11. Indicate the days or nights you are NOT available for work if any

12. If an offer of employment was extended to you, on what day can you start?

Name and Address of School Attended (High School)

Did you graduate?

• Yes
• No

Degree Received

Name and Address of School Attended (GED)

Did you graduate?

• Yes
• No

Degree Received

Major

Name and Address of School Attended (Other School)

Did you graduate?

• Yes
• No

Degree Received

Major

Name and address of college (College)

Did you graduate?

• Yes
• No

Degree Received

Major

Graduation Date

Please List technical skills, clerical skills, trade skills, relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)

Current Company

Type of Employment

• Full-Time
• Part-Time

Hours per Week

Address

computer responsibilities

Title

Date of Employment

Immediate Supervisor Name

Immediate Supervisor Phone Number

Base Salary (Start)

Base Salary (End)

Duties, responsibilities & accomplishments

Reason For Leaving

May we contact the employer?

• Yes
• No

Company

Type of Employment

• Full-Time
• Part-Time

Hours per Week

Address

Title

Date of Employment

Immediate Supervisor Name

Immediate Supervisor Phone Number

Base Salary (Start)

Base Salary (End)

Duties, responsibilities & accomplishments

Reason For Leaving

May we contact the employer?

• Yes
• No

Company

Type of Employment

• Full-Time
• Part-Time

Address

Hours per Week

Title

Date of Employment

Immediate Supervisor Name

Immediate Supervisor Phone Number

Base Salary (Start)

Base Salary (End)

Duties, responsibilities & accomplishments

Reason For Leaving

May we contact the employer?

• Yes
• No

Checkboxes *

• I certify that the information on this application and supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at later date. I authorize EMINENT Healthcare to investigate, without liability, all statements contained in this application and supporting materials. I authorize you to check my references with my former employers, without liability, and I agree to offer a complete response to any inquires made in connection with this employment application. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment. And that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that staff employees of EMINENT Healthcare serve at-will, and the employment relationship may be terminated at any time by either party or for any reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, to file a state security questionnaire and state loyalty oath, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible basis, I understand that I would be required to make mandatory contributions to the EMINENT Healthcare Retirement system or an optional retirement program, if applicable. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represents a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without the right of appeal.

PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION

Applicant Name *

Date

Resume Link (If unable to upload)

ID Link (If unable to upload)

Educational Certificate Link (If unable to upload)

License/Certificate Link (If unable to upload) (copy)

Checkboxes *

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