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Applicant Information

Applicant Name*

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Phone Number*

Are you legally able to work in the United States?*

Yes

No

Have you ever worked for this employer?*

Yes

No

Start & End Dates*

Date Available to Start*

MM slash DD slash YYYY

Position Applied for*

Employment Type*

Full-Time

Part-Time

Seasonal

If driving is required for role, are you okay with driving?*

Yes

No

Do you have a valid driver's license?*

Yes

No

Do you have valid vehicle insurance?*

Yes

No

High School

School Name*

Address

Did you graduate from High School/GED?*

Yes

No

Date Attended From

MM slash DD slash YYYY

Date Attended To

MM slash DD slash YYYY

Degree Earned

College/University

Name

Address

Did you graduate from college or university?

Yes

No

Date Attended From

MM slash DD slash YYYY

Date Attended To

MM slash DD slash YYYY

Degree Earned

Other School

School Name

Address

Did you graduate?

Yes

No

Date Attended From

MM slash DD slash YYYY

Date Attended To

MM slash DD slash YYYY

Degree Earned

Employment History

Please provide information for your previous three employers.

Most Recent Employer

Company*

Position Title*

Reason for leaving*

Dates of employment*

May we contact this employer?*

Yes

No

Contact Information

Second Employer

Company*

Position Title*

Reason for leaving*

Dates of Employment*

May we contact this employer?*

Yes

No

Contact Information

Third Employer

Company*

Position Title*

Reason for leaving*

Dates of Employment*

May we contact this employer?*

Yes

No

Contact Information

References

First Reference

Name*

Company*

Job Title*

Relationship*

eMail Address

Phone Number*

Second Reference

Name*

Company*

Job Title*

Relationship*

eMail Address

Phone Number*

Applicant Statement & Signature

Applicant Statement & Consent*

I agree to the statement below and consent to the application terms and requirements.

I certify that the information contained in this application is correct and complete to the best of my knowledge. I understand that any false or misleading information given in my application, resume, or interview(s) may result in Gateway Recovery Center’s determination to not offer employment or, in the event of employment it may result in discharge. I understand that all offers of employment are conditional upon satisfactory background checks and reference checks. If required, I consent to Gateway Recovery Center submitting any background checks applicable for my employment and to contact my references, for the purpose of verifying employment history and information offered in interviews and other job-related information as necessary. I will hold Gateway Recovery Center, background check entities, and all references contacted harmless for their actions related to the background check results and/or to the verification. I agree to abide by all Gateway Recovery Center policies and regulations, if I am hired. I understand that my employment will be for an indefinite term and that I may terminate the employment relationship and Gateway Recovery Center also may terminate the relationship, for any reason and without prior notification. Any modification of the terms of my employment relationship with Gateway Recovery Center must be in writing and signed by Gateway Recovery Center.

Applicant Signature*

Our Services

From psychological testing to therapy and medication management, our services cover all aspects of mental health care, ensuring comprehensive support and unmatched results.

Our Clinic

Whether virtual or in-person, experience a warm and inviting atmosphere where you feel immediately at ease.

Our Staff

Our team of leading professionals with years of experience and training ensure you receive only the highest quality care and support.

Schedule Now. We’re here to guide you.

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Crespoint Wellness

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Saint Paul, MN 55105-3382

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