LEARN MORE

For more information about Glenkirk programs and services, or to learn how you can get services contact us and get started.
Contact Person: Brian Bentz
3504 Commercial Avenue
Northbrook, Illinois 60062
Phone: 847-272-5111 ext. 546
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Application For Employment

Please print; use additional sheets if necessary. Conditions of employment are stated at the end of this form. Please read carefully before you sign and submit this application.
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PERSONAL INFORMATION
Please type your first name.
Please type your last name.
Please type your last name.
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GENERAL INFORMATION
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POSITION SPECIFICATIONS
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Please select a date when we should contact you.
POSITION CRITERIA
Are you willing to provide care to individuals, such as:
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Are you willing to assist individuals that have behavioral challenges if:
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Are you willing to assist individuals that have physical challenges by:
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ATTENDANCE AND PUNCTUALITY INFORMATION
Consistent attendance and punctuality are essential requirements of every job with this agency.
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EDUCATION
Grammar School
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High School
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College/ University
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Vocational/ Business
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Other School
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ADDITIONAL EXPERIENCE OR QUALIFICATIONS
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EMPLOYMENT HISTORY
(Starting with Most Recent)
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REFERENCES
(Do Not List Relatives)
Reference 1
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Reference 2
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NOTIFICATION AND AGREEMENT
I certify that all answers given by me are true, accurate and complete, i understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

Questions regarding this statement should be directed to the Human Resource Department before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

Glenkirk is a Smoke-Free and Drug-Free environment. It is the policy of the Agency to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, expunged juvenile records, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability, any and other characteristic protected by Federal, State, or Local law.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of the Agency rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the Agency or me, I further understand that no representation, whether oral or written by any representative or agent of the Agency, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President/CEO, or to make any agreement contrary to the foregoing.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.
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