Pre-Screening Form

Contact Information

Full Name

Email Address

Phone Number

Town/City

Are you over 18 years of age?
YesNo

Check the appropriate box below:

I am a New Applicant.

I am a Current GSIL Employee. Select your objective below.
---I'm looking for more hours.I would like to be added to the GSIL Registry and have read the registry Rules & Regulations.I'm looking for more hours and to be added to the GSIL Registry.

I am a Former GSIL Employee. When were you employed?

*I am interested in the following home care job openings:

Position Specific Information

Do you have any Personal Care experience?
YesNo

Do you have any experience with Personal Care equipment?
YesNo

Are you equally comfortable with male and female consumers?
YesNo

Are you comfortable in a smoking environment?
YesNo

Are you comfortable with pets, such as dogs and cats?
YesNo

Do you have any lifting restrictions?
YesNo

If a position requires driving, do you have 100/300 Liability on Auto Insurance?
YesNo

How many hours are you looking for?

Which days of the week are you able to work? Check all that apply.
SundayMondayTuesdayWednesdayThursdayFridaySaturday

What hours would you be able to work? Check all that apply.
MorningAfternoonEvening

Please list specific towns you are willing to drive to.

How did you learn about GSIL?
FacebookCraigslistFriend/FamilyGSIL WebsiteNewspaperSchool Job BoardOnline Job PostingOther

If Other, please let us know here:

What is the best time to reach you?

*This is a prescreen, applicants will have to complete a comprehensive New Hire packet if offered a position.

*Criminal background checks and BEAS checks are required of all employees for this position.