MENU
Home
About Us
Healthcare Organizations
Healthcare Professionals
Why Work With Us
Nursing Jobs
Allied Health Jobs
Contact Us
Blog
Employees
info@gohannastaffing.com
302-248-8181
1844-4-GoStaff
Home
About Us
Healthcare Organizations
Healthcare Professionals
Why Work With Us
Nursing Jobs
Allied Health Jobs
Contact Us
Blog
Employees
Employees
Job Seeker Application
JOB
SEEKER APPLICATION
If you have already spoken to someone from Gohanna Staffing Solutions, who did you speak to?
*
Michelle
Deborah
Nyeasha
I did not speak to anyone
Other
How did you learn about Gohanna Staffing Solutions, LLC? (If you were referred, please tell us who referred you.)
*
Website
Facebook
Indeed
Friend
Referred by
other
Referred by
*
DISCLOSURE 1: Gohanna Staffing Solutions, LLC is only interested in hiring staff who have strong clinical skills, who can work independently and those who act like professionals at all times. Agency staff are expected to be flexible, good communicators, responsible, helpful, friendly and provide a high level of care to their patients. Gohanna Staffing Solutions, LLC is not interested in hiring staff who do not follow directions, have a history of excessive call offs, tardiness, lack accountability, poor communicators or other behavioral issues on the job. I've read the above statement and understand.
*
Yes
No
DISCLOSURE 2: Gohanna Staffing Solutions, LLC is not your typical healthcare staffing company. We are not interested in hiring staff who only want to pick up here and there. We want staff who can communicate their availability and schedule a minimum of 24 hours a week on average in advance. We understand there are weeks that our staff will work less than the minimum due to illness, vacations, etc. Again, the expectation is an average of 24 hours a week. I've read the above statement and understand.
*
Yes
No
DISCLOSURE 3: Gohanna Staffing Solutions, LLC uses technology that helps us manage our employee files, schedule our staff, maintain compliance, process payroll and improve communication. We use these technologies in an effort to promote efficiency, reduce errors and provide a high level of service to our staff and facilities. As a result, our staff must be able to use technology by having the ability to send/receive text messages and emails. I've read the above statement and understand.
*
Yes
No
Personal Information
First Name
*
Last Name
*
Phone
*
Email Address
*
Address
Address
*
Address 02
City
*
State / Province
*
Postal / Zip Code
*
Country
*
United States of America
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (see Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
How long have you lived in the above state?
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
Specialty License #?
*
What is your Specialty?
*
RN
LPN
CNA
Non-Certified Aide
MA
OTHER
Is your professional license in good standing?
*
Yes
No
Unsure
N/A
Has your professional license ever been suspended, revoked or managed by PNAP? If yes, please explain:
*
Who do we contact in the event of an emergency?
*
Emergency contact phone number:
*
When can you start?
*
Date Format: MM slash DD slash YYYY
How many hours a week do you want to work?
*
16
24
32
40
40+
Can you pass a drug screen?
*
Yes
No
Maybe
Prescribed By Dr.
Do you have reliable transportation?
*
Yes
No
Sometimes
How frequently do you call off work?
*
Once A Month
Few Times A Month
A Few Times A Year
I Call Off Often
Never
Select all of the shifts you are willing to work:
Weekdays
*
Morning (7-3)
Afternoon (3-11)
Night (11-7)
Weekends
*
Morning (7-3)
Afternoon (3-11)
Night (11-7)
Do you have a criminal record? If so, please explain:
*
Do you have any disabilities that require us to help assist you in the work place? If yes, please explain:
*
Do you have any issues with getting to work on time? If yes, please explain:
*
Upload your resume here (PDF):
*
Accepted file types: pdf, docx.
CURRENT or MOST RECENT EMPLOYER
Company
*
Specialty
*
RN
LPN
CNA
MA
SITTER
RT
PT
LSW
CRNA
DR
OTHER
Phone Number
*
Address
Employer Address
*
Employer Address 02
City
*
State / Province
*
Postal / Zip Code
*
Country
*
United States of America
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (see Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Do you have additional comments you would like to share about your employment status?
*
Start Date
*
Date Format: MM slash DD slash YYYY
End Date
*
Date Format: MM slash DD slash YYYY
CURRENT or MOST RECENT EMPLOYER(Optional)
Company
Specialty
RN
LPN
CNA
MA
SITTER
RT
PT
LSW
CRNA
DR
OTHER
Phone Number
Address
Employer Address
Employer Address 02
City
State / Province
Postal / Zip Code
Country
United States of America
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (see Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Do you have additional comments you would like to share about your employment status?
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
REFERENCE #1 (Please provide professional references; co-workers or supervisors)
Full Name
*
How long have you known this person
*
How do you know this person?
*
Co-worker
Supervisor/Manager
Can we contact this person?
*
Yes
No
Phone Number
*
REFERENCE #2 (Please provide professional references; co-workers or supervisors)
Full Name
*
How long have you known this person
*
How do you know this person?
*
Co-worker
Supervisor/Manager
Can we contact this person?
*
Yes
No
Phone Number
*
REFERENCE #3 (Please provide professional references; co-workers or supervisors)
Full Name
How long have you known this person
How do you know this person?
Co-worker
Supervisor/Manager
Can we contact this person?
Yes
No
Phone Number
Gohanna Staffing Solutions, LLC is always looking to hire awesome people. If we end up hiring your referral and they work 40 hours you will receive a $150 referral bonus! If you can think of anyone please let us know!!
Name:
*
Phone Number:
*
Specialty:
*
RN
LPN
CNA
MA
SITTER
RT
PT
LSW
CRNA
DR
OTHER
DISCLOSURES
ELECTRONIC SIGNATURE CONSENT
As part of the selection process atGohanna Staffing Solutions, LLC, the "Company," you will need to consent to a background check electronically. By typing your name, you are consenting to receive any communications (legally required or otherwise) and all changes to such communications electronically. To use the website, you must provide at your own expense an Internet connected device that is compatible with the minimum requirements outlined below. You also confirm that your device will meet these specifications and requirements and will permit you to access and retain the communications electronically each time you access and use the website.
SYSTEM REQUIREMENTS TO ACCESS INFORMATION
To receive and view an electronic copy of the Communications you must have the following equipment and software: A personal computer or other device which can access the Internet. Your access to this page verifies that your system/device meets these requirements. An Internet web browser which can support 128-bit SSL encrypted communications, JavaScript, and cookies. Your system or device must have 128-bit SSL encryption software. Your access to this page verifies that your browser and encryption software/device meet these requirements.
SYSTEM REQUIREMENTS TO RETAIN INFORMATION
To retain a copy, you must either have a printer connected to your personal computer or other device or, alternatively, the ability to save a copy through use of printing service or software such as Adobe Acrobat®. If you would like to proceed using paper forms, please contact Gohanna Staffing Solutions, LLC.
WITHDRAWAL OF ELECTRONIC ACCEPTANCE OF DISCLOSURES AND NOTICES
You can also contact us to withdraw your consent to receive any future communications electronically, including if the system requirements described above change and you no longer possess the required system. If you withdraw your consent, we will terminate your use of the CSS Inc. website and the services provided through CSS Inc. website. To ensure that a signature is unique and to safeguard you against unauthorized use of your name, your IP address has been recorded and will be stored along with your electronic signature. Please note that if you wish to submit your Disclosure and Authorization Forms electronically,Gohanna Staffing Solutions, LLC requires that you include your social security number or user identification. All your information will be encrypted and transmitted via our secure website.
DISCLOSURE FOR INVESTIGATIVE CONSUMER REPORT
Gohanna Staffing Solutions, LLC (the "Company") may request an investigative consumer report about you from a third-party consumer reporting agency, in connection with your employment or application for employment. An "investigative consumer report" is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews). The most common form of an investigative consumer report in connection with your employment is a reference check through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, or mode of living. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company. If adverse action is taken resulting from information obtained, in whole or in part, from an investigative consumer report from a consumer reporting agency, you will have the option to receive a copy of the report fromGohanna Staffing Solutions, LLC. Gohanna Staffing Solutions, LLC can be contacted at 2366 Golden Mile Highway #411, Pittsburgh, PA 15239 or by phone/fax at 877-361-1196.
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
Gohanna Staffing Solutions, LLC (the "Company") may obtain information about you from a third-party consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, or other background checks. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by Gohanna Staffing Solutions, LLC. 877-361-1196 Golden Mile Highway #411, Pittsburgh, PA 15239. To the extent permitted by law, the Company may obtain consumer reports from any outside organization throughout the course of your employment.
ACKNOWLEDGMENT AND AUTHORIZATION
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT]
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and certify that I have read and understand both of those documents. I hereby authorize the procurement of "consumer reports" and/or "investigative consumer reports" at any time after receipt of this authorization and, if I am hired, throughout my employment. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Gohanna Staffing Solutions, LLC can be contacted at 2366 Golden Mile Highway #411, Pittsburgh, PA 15239, http://www.gohannastaffingsolutions.com, another outside organization acting on behalf of Gohanna Staffing Solutions, LLC ("the Company"), and/or the Company itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.
Consent
*
I authorizing Gohanna Staffing Solutions, LLC to conduct the background checks described above.
Consent
*
I am consenting to use electronic means to sign this form and have read all of the above disclosures.
*
Consent
*
I acknowledge that I may request a hard copy of this Disclosure and Authorization form after agreeing to the background check electronically by calling Gohanna Staffing Solutions, LLC at 877-361-1196.
*
Consent
*
I understand that by signing/typing my name, entering the last four digits of my social security number and clicking on submit, constitutes my electronic signature, dated as of when I clicked the "submit" button.
*
Last 4 of SSN:
*
As a healthcare provider we expect you have certain credentials. If you have any of the following credentials please upload them below: Copy of Driver's License, Copy of Nursing License, CPR Certification, PPD/TB results (or recent chest xray), Immunizaiton Records, Drug Screen, PA Criminal Report, Child Abuse Clearance. Not all of these items are required, but if you have any of them please upload them below.
Upload Files
*
Drop files here or
Accepted file types: pdf, docx.
This iframe contains the logic required to handle Ajax powered Gravity Forms.
Home
About Us
Healthcare Organizations
Healthcare Professionals
▼
Why Work With Us
Nursing Jobs
Allied Health Jobs
Contact Us
Blog
Employees