Please complete the following employment application. This is a full application. If you are a match for on of our openings you will be contacted by G.B. Cooley. We thank-you for your interest in G. B. Cooley and invite your friends and family to visit our website and complete their own employment application.

G.B.Cooley Hospital Service District supports the philosophy that all people should be empowered with the opportunity to live life its fullest.

We do not believe in providing custodial care, but rather believe in teaching and empowering persons to do for themselves. Therefore, we do not employ persons strictly as drivers, sitters, cooks, or housekeepers. Direct Support Professionals are responsible for training and assisting to the degree required for people served by G.B.Cooley Hospital Service District in all areas of daily living.

All staff is responsible for reporting to a Home Manager and following the chain of command. Each employee is responsible for full and automatic documentation of training sessions, medical needs, home needs, maintenance needs, and other pertinent paperwork. Each employee will receive training in completing and properly processing all forms.

G.B. Cooley Hospital Service District adheres to all policies and procedures outlined in the G.B. Cooley Human Resources Manual. Upon employment, all staff is responsible for obtaining a full and functional knowledge of the information contained In the document.

QUALIFICATIONS

To be eligible for employment with G.B. Cooley Hospital Service District, you must meet the following criteria:

  1. Must be at least 21 years of age (due to our vehicle insurance provider)
  2. Must have a High School Education or GED
  3. Must have a valid drivers license
  4. Must be able to pass a drug test
  5. Must have a clear criminal background
  6. Must be free of communicable diseases
  7. Must have a satisfactory motor vehicle report
  8. Must be in good physical and mental health.

ADDITIONALLY:

  1. Must present an acceptable standard re appearance
  2. Must be able to work in a fast paced and stressful environment.
  3. Must have reliable transportation.
  4. Must be awake, alert, and observant during all duty hours.
  5. Must be willing to work flexible hours.
  6. Must have own telephone or a means by which you can he quickly contacted.
  7. Must be reliable, prompt, and adhere to work schedule.
  8. Must realize that if you are holding other jobs outside G.B.Cooley, we are your primary employer and DEMAND first scheduling considerations
  9. Staff are not allowed to bring children to work; this includes work hours, meetings, etc.
  10. Must be able to attend each day of scheduled New Employee Orientation without excuse or exception, being certain to be on time for each class

If you fail to meet ANY of the criteria above, you are not eligible for employment with G.B.Cooley.

All individuals selected for a personal interview should bring with them to the interview, originals of the following documents. We will make copies. Please note Mat you will NOT be able start New Employee Orientation until we have made a copy of your:

  • Social Security Card
  • Drivers license
  • Proof of education
  • Proof of vehicle insurance

RELIEF STAFF
Please be aware that if you are hired as a relief staff you are to contact HR Dept. each Monday morning with a schedule you will be able to work. Also note that if you cannot come to work when called three (3) consecutive times or we cannot get in contact with you three (3) consecutive times, we will no longer call you to work and it will be acknowledged that you have resigned. (Your called-in schedule will be taken into consideration re: the previous statement.) In addition, if hired as part time or full time staff and you fail To work your scheduled shift 3 times or fail to contact supervisor concerning your absence or tardiness within 2 hours prior to beginning of shift 3 times, it will be acknowledged that you no longer want so work for G.B. Cooley and have resigned (and a no rehire will be placed in your file).

I have read the previous information and understand. I feel I meet the qualifications listed above and I can supply the required documents prior to being hired.  

This is a lengthy application. Please read carefully and complete all possible information. Applications with incomplete necessary details will be discredited.

Note: Pursuant LA.R.S. 14:126.3 (Crime of Health care facility application fraud) Falsification of this application is punishable by law.
* Required














Education and Training


  9th  10th  11th  12th  GED




Personal Data Questionnaire

  Yes  No
  Yes  No
  Yes  No
  Yes  No
  Yes  No
  Yes  No
  Yes  No
 
 
  Yes  No
 
  Yes  No

Employment History:

Start with most current employer

By submitting this application, the applicant gives permission to G.B. Cooley Hospital Service District to contact the references and releases the persons providing references from liability to the fullest extent provided by LA.Rev.Stat.23:291









Yes  No





References

List 4 people who are not related to you and who have definite knowledge of your qualifications and fitness for the position for which you are applying.

1



2



3



4




Yes  No



Yes  No



Yes  No



Yes  No

Pre-employment Authorization & Certifications


Yes  No


In an attempt to judge the effectiveness of our recruitment efforts, we ask that you provide the following OPTIONAL information. G.B. Cooley Hospital Service District is an Equal Opportunity Employer and this information will IN NO WAY be used in the decision to hire or promote.
  Male  Female
  Asian  Black  Hispanic  White  Other
  Non Veteran  Veteran  Disabled Veteran
  Yes  No




Preferences & Tolerances


  Monday  Tuesday  Wednesday  Thursday
Friday    Saturday  Sunday        No Preference
  Monday  Tuesday  Wednesday  Thrusday
Friday    Saturday  Sunday        No Preference
 
  Younger (under 12 years of age)  Teens (12-18 years)  Young adult (19-25 years)       Older adult (26-50 years)
Senior (51+years)

What are your tolerances? Can you handle the following from a person who is developmentally disabled?

  Yes  No
  Yes  No
  Yes  No
  Yes  No
  Yes  No

Yes  No
I understand
If hired, I understand that I am free to resign at any time. Furthermore, it is acknowledged that employment with G.B.Cooley Hospital Service District is at-will and the at-will nature cannot be changed except by separate written agreement. The employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary.

By submitting this application, the applicant gives consent for G.B. Cooley Hospital Service District to conduct background checks including obtaining criminal records, and acknowledges that the immunity granted from civil liability shall be the most extensive allowed by law, including LA. Rev. Stat. 23:291(D)

By submitting this application, the applicant acknowledges that the application submitted is true, accurate, complete, and correct and any misrepresentations or omissions may result in the application being disregarded and the prospective employee not being considered for employment, or if hired, cause for discipline including discharge, and if tired, forfeiting workers compensation benefits.


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