Pre-Screening Form

Contact Information

Full Name

Email Address

Phone Number


Are you over 18 years of age?

Check the appropriate box below:

Select your objective below.

When were you employed?

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

Position Specific Information

Starting wage is $10.25/hr. - $10.75/hr.

Do you have any Personal Care experience?

Do you have any experience with Personal Care equipment?

Are you equally comfortable with male and female consumers?

Are you comfortable in a smoking environment?

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

Do you have any lifting restrictions?

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

How many hours are you looking for?

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

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

Please list specific towns you are willing to drive to.

How did you learn about GSIL?

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.

Click here to learn more about our Home Care Services.