Gurnee Radiology Centers

Join Our Team

If you are interested in a career opportunity with our company, please complete the form below. Thank you for your interest in GRC!

Contact Information

First Name:*	*required
Middle Initial:
Last Name:*
Home Phone:*	Preferred Phone Number
Work Phone:	Preferred Phone Number
Cell / Mobile Phone:	Preferred Phone Number
Pager Number:	Preferred Phone Number
Email:*

Position Information (if hired)

Are you a U.S. citizen, or an alien legally authorized to work in the United States?*
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Are you 18 years of age or older?
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Please specify your Work Shift preference:* Select all that apply.	ANY Days Evenings
Job Position Applied For: *

Education

High School:
Last Year Completed:
Did you graduate?	Yes No

College:
Course of Study:
Last Year Completed:
Did you graduate?	Yes No
Degree Earned:

Other College or Trade School:
Course of Study:
Last Year Completed:
Did you graduate?	Yes No
Degree Earned:

Other Education:

Licensing and Registration

Professional License / Certification:	Currently Licensed in the state of Illinois Currently Registered in the state of Illinois Eligible for License Eligible for Registration None
What type of license / certification do you have / are you eligible for?

Has this License or Registration EVER been suspended, revoked or on probation?
Yes No
Explain:

Employment History

Current or most recent employment:
Job Title:
Employer:
From:
To:
Salary:
Supervisor:
Supervisor Phone Number:
Duties:
Reason for Leaving:

Previous Employment:
Job Title:
Employer:
From:
To:
Salary:
Supervisor:
Supervisor Phone Number:
Duties:
Reason for Leaving:

Previous Employment:
Job Title:
Employer:
From:
To:
Salary:
Supervisor:
Supervisor Phone Number:
Duties:
Reason for Leaving:

May we contact the employers listed above?
Yes No
If not, please indicate which ones you do not wish us to contact?

For reference purposes, if you were under another name for any of the above employers, please indicate that name:

Criminal History

Note: Conviction means you were found guilty by a judge, a jury, by pleading "no contest," or by pleading guilty in court. A conviction may have taken place even if you did not pay a fine or spend any time in jail or prison. A conviction will not automatically disqualify you from employment.
Have you ever been convicted of a felony or a misdemeanor (including, but not limited to such offenses as DUI, battery, theft, writing worthless checks, etc.)?*
Yes No
If yes, what charges and dates?
Have you ever pled nolo contendere or pled guilty to a crime, which is a felony or a misdemeanor (including, but not limited to such offenses as DUI, battery, theft, writing worthless checks, etc.)?*
Yes No
If yes, what charges and dates?
Have you ever had the adjudication of guilt withheld to a crime, which is a felony or a misdemeanor (including, but not limited to such offenses as DUI, battery, theft, writing worthless checks, etc.)?*
Yes No
If yes, what charges and dates?

Confirmation

Agree Disagree*

I have completed all appropriate fields on the above application, and have read the following paragraph:

I understand that I might have to work rotating shifts and am able to do so. I certify that all of the information I have given in this document is accurate and complete and is subject to verification by GRC. In addition, my previous and present employers may be asked for information relative to my employment record with them. I understand that any omission or misrepresentation of material facts in this document may result in disqualification and/or disciplinary action. Further, in cases where job specifications state that I must meet certain educational requirements, I must be able to submit to the Human Resources Department: a high school diploma, general educational development (GED) certificate, a transcript of my college credits and/or copy of my degree, diploma or certification, as appropriate.

Please Note: This online application is not an offer for a contract of employment.