Careers

Application Process

Please carefully review the application guide provided below.

Application Guide:

Kindly download the following documents and complete them with your information. These will be required as part of your employment application process.

When submitting your application, you have two options: either fill out the application form on this page submit it, and upload the filled-out copies of the W4 and W9, or download the Application Form, alongside W4 and W9, complete it, and upload it. Below is the process if you choose the latter.

Click on the “Download Application Form” button below to download the application form to your device. Open the downloaded application form and read the instructions provided. Ensure that you understand each section before proceeding.

Fill out all required fields in the application form. Provide accurate and detailed information about your qualifications and experiences.

Return to the Golden Haven Services website (Careers) and look for the “Upload” button associated with the job application process.

Fill out the short form and upload your filled-out forms including the W4 and W9

Once your upload is successful, a confirmation message will be displayed on the screen. This confirms that your application has been received by Golden Haven Services.

If you have any questions or encounter issues during the application process, please contact our Human Resources department at [email protected]

We appreciate your interest in joining Golden Haven Services. Best of luck with your application!

Application Form

Careers

PERSONAL INFORMATION

Required Information

First Name

Last Name

Social Security

Date

Address

City

State

Zip Code

Country

Cell Phone

Home Phone

Emergency Contact

Address

Phone Number

Gender

Are you 18 or older? (If no, we will verify your legal age to work)

Position (s) applying for

Are you a U.S. citizen or an individual authorized to work in the United States?

Salary/ Wage desired

Have you ever been employed by Golden Haven Services?

Give dates employed

Have you ever been convicted of a felony?

EDUCATION/SKILLS

1. High school

Location

Did You Graduate or Obtained Degree?

No. of Years attended

Phone

Subject

2. College

Location

Did You Graduate or Obtained Degree?

No. of Years attended

Phone

Subject

3. Trade, Business or Correspondence School

4. List any experiences, special skills or qualifications that would be of special benefit to the Job for which you are applying for

PROFESSIONAL LICENSES AND OR CERTIFICATES

1. Organization

State Issued

2. Organization

State Issued

Phone

Date Issued

Phone

Date Issued

AREAS OF EXPERTISE

Please indicate experience in month and years.

Private Duty Nursing

Children’s Home

Correctional Facilities

Case Manager

Child Care/Development

Clinics

Quality Assurance

Hospice

Nursing Home

Occupational/Industrial

Utilization Review

Dialysis Center

Doctor’s Office

Other

Home Health Visits

Adult

Pediatric

Infusion

Home Health Visits

HOSPITAL EXPERIENCE

Please indicate experience in month and years.

Med/Surgery

Emergency Room

Pediatrics

Oncology

Psychiatric/ Behavioral medicine

LTAC

Orthopedics

Intensive Care (ICU/CCU/SICU/MICU)

Neurology

Telemetry

Nursery

Operating/Recovery Room

Intensive Care (Neonatal ICU/Pediatric ICU)

Rehabilitation

Pediatric Progressive Care

Nephrology

EMPLOYMENT HISTORY

Please provide three most recent employment histories.

1. Current or last employer

Phone

Period, (From)

Supervisor

Position & Duties

Employer

Address

Period (To)

Weekly Wages $

Reason for Leaving

2. Current or last employer

Phone

Period, (From)

Supervisor

Position & Duties

Employer

Address

Period (To)

Weekly Wages $

Reason for Leaving

3. Current or last employer

Phone

Period 3 (From)

Supervisor

Position & Duties

Employer

Address

Period (To)

Weekly Wages $

Reason for Leaving

4. Please explain all periods of unemployment

Have you ever been terminated from employment, if Yes, please explain below .

Please explain

REFERENCES

1. Name

Address

Phone

Yrs. Acquainted

2. Name

Address

Phone

Yrs. Acquainted

3. Name

Address

Phone

Yrs, Acquainted

Transportation

You must complete the following section if you are applying for a position that involves operating a motor vehicle owned or leased by the agency, or if you will be using your own vehicle for agency purposes.

1.Driver's License #

State Issued

Exp. Date

2. Do you have auto liability insurance?

Name of insurance company

Expiration date

3. Has your driver's license ever been suspended or revoked for any reason?

Date of incident(s)

Severity of the incident(s)

TRAFFIC VIOLATIONS RECORD

List the traffic citations that you have received during the last five (5) years preceding date of this Application, and state the disposition of each, as "dismissed", "paid fine", "defensive driving", etc.

1. Date

2. Date

3. Date

Type

Disposition

If you have operated a vehicle while intoxicated or under the influence, kindly provide an explanation:

Note: If you are selected for a position that involves driving, please ensure you keep us informed of any changes in your driving record.

NOTICE TO PROSPECTIVE EMPLOYEES

By submitting this application, I confirm that the information provided is accurate, truthful, and complete to the best of my knowledge. I assure that I have accurately recorded all my work experiences and training without intentionally withholding any relevant facts. Golden Haven Services is hereby granted permission to conduct investigations into my employment, educational, credit, or criminal history through any chosen investigative agencies or bureaus. I release all relevant parties from any liability for damages resulting from providing such information.

I acknowledge the requirement to be capable of performing the essential functions of the applied job. I understand that my employment is subject to a mobility evaluation, and I consent to maintaining a favorable drug/alcohol screening. I also agree that any information concerning said physical examination can be disclosed to the authorized agent of this agency upon request.

If employed by Golden Haven Services, I commit to adhering to its rules and regulations. I understand that the discovery of misrepresentation or omission of facts herein may result in immediate dismissal. I grant Golden Haven Services permission to make any necessary inquiries to complete my employment file.

Understanding that operating conditions may require temporary or permanent changes in shifts, I agree to such scheduling adjustments as directed by my supervisor. I further comprehend that this application for employment does not constitute an employment contract. If employed, I acknowledge that such employment is for an indefinite period and may be terminated at will by either party, with at least two weeks' notice in writing, at any time, for any or no reason. Additionally, I understand that the terms of employment, including wages, conditions, benefits, and operating policies, are subject to change. If employed, I commit to completing an employment verification form and providing satisfactory evidence of identity and eligibility for employment within five days.

Do you have physical and/or mental capability to perform the essential functions of the Job?

State the accommodations that would allow you to perform the job:

APPLICANT STATEMENT

By submitting this application, I certify that the answers provided herein are true, correct, and complete to the best of my knowledge. I affirm that I have accurately documented all my work experience and training, withholding no known facts or circumstances that should have been disclosed. Golden Haven Services is hereby granted authorization to conduct investigations into my employment, educational, credit, or criminal history through any chosen investigative agencies or bureaus. I release all relevant parties from any liability for damages resulting from providing such information.

I acknowledge the necessity of being capable of performing the essential functions of the job for which I am applying. I understand that my employment is subject to mobility evaluation, and I consent to maintaining a favorable drug/alcohol screening. I also agree that any information concerning said physical examination can be disclosed to the authorized agent of this agency upon request.

Should I be employed by Golden Haven Services, I commit to adhering to its rules and regulations. I am aware that the discovery of misrepresentation or omission of facts herein may result in immediate dismissal. I grant Golden Haven Services permission to make any necessary inquiries to complete my employment file.

Recognizing that operating conditions may require temporary or permanent changes in shifts, I agree to such scheduling adjustments as directed by my supervisor. I further understand that this application for employment does not constitute an employment contract. If employed, I acknowledge that such employment is for an indefinite period and may be terminated at will by either party, with at least two weeks' notice in writing, at any time, for any or no reason. Additionally, I understand that the terms of employment, including wages, conditions, benefits, and operating policies, are subject to change. If employed, I commit to completing an employment verification form and providing satisfactory evidence of identity and eligibility for employment within five days.

Date

By agreeing to this GDPR Agreement, you confirm that you have read, understood, and consent to the processing of your data as outlined above. If you do not agree with these terms, please refrain from submitting your application.

Signature

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