"An Equal Opportunity Employer"

* Required Field

Employment Experience

Please start with your present or last job. Include military service assignments and volunteer activities.

Exclude organization names which indicate race, color, religion, sex or national origin.


Military Service


Please list the names, addresses and phone numbers of three individuals, other than relatives, that may be contacted for a reference. Two of these individuals should be work related.

Emergency Information

Please list the name, address and phone number of an individual to be contacted in the case of an emergency

Applicant's Statement

Application will not be accepted if this oath is omitted

I solemnly swear or affirm that the answers I have made to each and all of the questions are complete and true to the best of my knowledge and belief. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I hereby waive all provisions of law forbidding my physician or other person who has attended or examined me, or who may hereafter attend or examine me, colleges or universities which I attended, or past employers from disclosing any knowledge or information which they thereby acquired relevant to my employment and I hereby consent that they may disclose such knowledge or information to Green Hills Community. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract for employment.