Gypsy Hill Place: Contact Us

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Gypsy Hill Place

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If you wish to be considered for future employment opportunities
with Gypsy Hill Place, fill out and submit the form below.

Roe Truelsen, Director of Campus Operations
TEL (540) 712-0620 | EMAIL rtruelsen@gypsyhillplace.com
300 Churchville Avenue, Staunton, VA 24401

Employment Application
First Name
Middle Name
Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Social Security Number
Home Phone Number
- Area Code Phone Number
Cell Phone Number
- Area Code Phone Number
E-mail
Do you have a valid Driver’s License in the State of Virginia?
Are you eligible to work in the United States?
If you are under age 18, do you have an employment/age certificate?
Have you been convicted of a felony within the last five years?
If yes, please explain:
Position of interest:
Available Days/Hours
Monday
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Tuesday
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Wednesday
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Thursday
From To
Friday
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Saturday
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Sunday
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Start date availability:
Month Day Year
Education and Skills
Name and Location of School; Type of Degree/Diploma; Graduation Date
Name and Location of School; Type of Degree/Diploma; Graduation Date
Name and Location of School; Type of Degree/Diploma; Graduation Date
Skills and Qualifications: Licenses, Skills, Training, Awards
Employment History
Present or Last Position:
Employer

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Supervisor
Phone Number
- Area Code Phone Number
E-mail
Position Title
From
Month Day Year
To
Month Day Year
Responsibilities
Salary
May We Contact Your Present Employer?
Previous Position:
Employer

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Supervisor
Phone Number
- Area Code Phone Number
E-mail
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To
Month Day Year
Responsibilities:
Salary
Reason for Leaving
References
Name/Title

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
2nd Reference
Name/Title

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
3rd Reference
Name/Title

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
By submitting this form, I certify that all information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed.
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