Gateway Services INC
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Application for Employment
We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital, or veteran status, the presence of a non job-related medical condition or handicap, or any other legally protected status.
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Indicates required field
Position(s) applied for
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How did you learn about us?
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Advertisement
Friend
Relative
Employment Agency
Walk-in
Other
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Social Security Number
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Email
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If less than 18 years of age, can you provide required proof of your eligibility to work?
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Yes
No
Have you ever filled out an application with us before?
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Yes
No
Are you currently employed?
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Yes
No
Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Proof of citizenship or immigration status will be required upon employment.
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Yes
No
On what date will you be available for work?
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Are you available to work?:
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Full Time
Part Time
Shift Work
Temporary
Are you currently on layoff status and subject to recall?
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Yes
No
Can you travel if a job requires it?
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Yes
No
Can you work late evenings or weekends if a job requires it?
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Yes
No
Have you been convicted of a felony within the last 7 years?
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Yes
No
If yes, please explain...
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Education
Elementary School
School name and location
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Years completed
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4
5
6
7
Diploma/Degree
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High School
School name and location
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Years completed
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9
10
11
12
Diploma/Degree
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Describe course of study
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Describe any specialized training, apprenticeship, skills, and extra-curricular activities
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Describe any honors you have received
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State any additional information you feel may be helpful to us in considering your application
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Undergraduate College
School name and location
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Years completed
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1
2
3
4
Diploma/Degree
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Describe course of study
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Describe any specialized training, apprenticeship, skills, and extra-curricular activities
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Describe any honors you have received
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State any additional information you feel may be helpful to us in considering your application
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Graduate/Professional
School name and location
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Years completed
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1
2
3
4
Diploma/Degree
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Describe course of study
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Describe any specialized training, apprenticeship, skills, and extra-curricular activities
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Describe any honors you have received
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State any additional information you feel may be helpful to us in considering your application
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Indicate any foreign languages you can speak. read, and/or write.
Speak fluently
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Read fluently
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Write fluently
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Speak well
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Read well
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Write well
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Speak fair
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Read fair
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Write fair
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List professional, trade, business, or civic activities and offices held. (You many exclude memberships, which would reveal sex, race, national origin, age, ancestry, or handicap or other protected status.)
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References
Give name, address and telephone number of three references who are not related to you and are not previous employers.
Reference #1 Name
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First
Last
Reference #1 Phone Number
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Reference #1 Address
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Line 1
Line 2
City
State
Zip Code
Country
Reference #2 Name
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First
Last
Reference #2 Phone Number
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Reference #2 Address
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Line 1
Line 2
City
State
Zip Code
Country
Reference #3 Name
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First
Last
Reference #3 Phone Number
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Reference #3 Address
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Line 1
Line 2
City
State
Zip Code
Country
Have you ever had any job-related training in the United States Military?
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Yes
No
If yes, please describe:
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Are you physically or otherwise unable to perform the duties of the job for which you are applying?
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Yes
No
Employment Experience
Start with your present or last job. Include job-related military service assignments and volunteer activities. (You many exclude organizations that indicate race, color, religion, gender, national origin, handicap or other protected status.)
Employer
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Phone Number
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Date employed from
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Rate/salary start
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Job title
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Date employed to
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Rate/salary end
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Work performed
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Reason for leaving
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Employer
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Phone Number
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Date employed from
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Rate/salary start
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Job title
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Date employed to
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Rate/salary end
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Work performed
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Reason for leaving
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Employer
*
Phone Number
*
Date employed from
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Rate/salary start
*
Job title
*
Date employed to
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Rate/salary end
*
Work performed
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Reason for leaving
*
Employer
*
Phone Number
*
Date employed from
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Rate/salary start
*
Job title
*
Date employed to
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Rate/salary end
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Work performed
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Reason for leaving
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Special skills and qualifications:
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Applicant's statement:
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature of Applicant
*
Date
*
Submit
Home
Employment Application
Gateway Services
Day Services
Employment Services
Transition Services
Deaf Services
Respite
About Us
Gallery
Links
Contact Us
Access Johnson County
NOW HIRING
ADA Partransit Plan
ADA Application
Fares
Reasonable Modification Policy
Reasonable Mod Camplaint Form
Riders Guide
Route Map
Schedules
Mission
Public Notice of Rights
Construction Updates
CLOSINGS
Ride
Contact Us
Advertise
Meet our Staff
Awards
Links
Blog
Access Johnson County
Public Notice of Rights