Careers

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Start a fulfilling career making a real difference. First, select which company you are applying to.

Step 1 — Select a Company

Choose the company you are applying to. Your application and PDF will be customized accordingly.

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Employment Application

Company Name

1395 E Granville Rd, Suite 302 • Columbus, OH 43229

(614) 495-8934 • Fax: (614) 495-8952 • info@global-hhc.com

Applying to: Company Name

👤 Personal Information

First Name *

Middle Name

Last Name *

Street Address *

Apt / Suite

City *

State *

ZIP Code *

Email *

Phone *

Social Security Number

Date of Birth *

Emergency Contact

How were you referred to us?

Family/Friend Employee Internet Other:

💼 Job Interests

Date Available *

Anticipated Wage ($/hr)

Position Applied For *

📝 Employment Eligibility

Are you legally authorized to work in the U.S.? *

Yes No

Have you ever been employed by this company before?

Yes No

Have you ever been convicted of a felony?

Yes No

Can you pass a pre-employment drug test?

Yes No

🏢 Work History (Min. 2 required — most recent first)

Employer 1 REQUIRED

Company Name *

Phone

Street Address *

City *

State / ZIP *

Job Title *

Wage *

From *

Primary Responsibilities *

Supervisor Name *

Supervisor Phone *

Reason for Leaving *

Employer 2 REQUIRED

Company Name *

Phone

Street Address *

City *

State / ZIP *

Job Title *

Wage *

From *

Primary Responsibilities *

Supervisor Name *

Supervisor Phone *

Reason for Leaving *

Employer 3 (Optional)

Company Name

Phone

Job Title

Wage

From

Reason for Leaving

🎓 Education

High School Name

City / State

Year Graduated

College / University

City / State

Year Graduated

Degree / Major

📜 Licenses & Certifications

#	License or Certification	ID / License Number	Expiration (MM/YYYY)	State
1
2
3

👥 Professional References (2 required)

Reference 1 REQUIRED

Full Name *

Phone *

Address / City *

Relationship to Applicant *

Position / How Long Known *

Reference Type

Professional Personal

Reference 2 REQUIRED

Full Name *

Phone *

Address / City *

Relationship to Applicant *

Position / How Long Known *

Reference Type

Professional Personal

📑 Policy Acknowledgments

Please read each policy carefully before signing.

Application Acknowledgment

I certify that all answers are true, accurate, and complete. False or misleading information may result in termination. I authorize this company to verify all information and conduct a criminal background investigation. I release the company from any liability from such investigation. If employed, I am an employee at will. I am willing to submit to drug screening per applicable laws.

Drug-Free Workplace

I will abide by the Drug-Free Workplace program as a condition of employment and will notify the employer of any drug-related criminal conviction within 5 days of such conviction.

Abuse Policy

Mistreatment in the form of verbal or physical abuse of any patient is not tolerated and is grounds for immediate termination. Local authorities will be notified and criminal charges may be filed.

Confidentiality & HIPAA

I will maintain the confidentiality of all patient information in compliance with HIPAA and applicable law. This obligation continues after my employment ends.

Incident Reporting

I must immediately report to the company if a client is hospitalized, refuses services, changes address, or any incident occurs. Falsifying timesheets is grounds for termination and legal action.

✍️ Agreements & Signature

I will report ALL accidents to my supervisor immediately, no matter how slight.

I Agree

I will wear all required Personal Protection Equipment (PPE) at all times.

I Agree

I attest that the above referenced information is true and accurate to the best of my knowledge. I give the agency permission to call any cited employer or reference for information regarding my character, employment history, or work ethics.

Print Full Legal Name *

Date *

Electronic Signature — Type your full name *

🔒 By typing your name you are providing your legally binding electronic signature.

🕒 Generating your PDF and sending email… please wait.

✓ Application submitted! Your PDF is downloading and a copy has been sent to our HR team.
We will review your application and contact you at the email provided. Thank you!

Questions? Contact HR

We are happy to answer any questions about open positions.

📞 (614) 495-8934✉ info@global-hhc.comFax: (614) 495-8952