EMPLOYMENT / JOB APPLICATION I. PERSONAL INFORMATION Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Cell Phone * (###) ### #### Home Phone * (###) ### #### Date Available * MM DD YYYY Desired Pay * Check One * Hourly Salary Position Applying For (Choose One) * Maintenance Technician Custodian Service Coordinator Intake Recertification Receptionist/Intake Specialist Accountant Property Manager Desired Location Akron, OH Alliance, OH Ashtabula, OH Campbell, OH Chicago, IL Cleveland, OH Cuyahoga Falls, OH Massillon, OH Ravenna, OH Warren, OH Wooster, OH Employment Desired * Full-Time Part-Time Seasonal II. EMPLOYMENT ELIGIBILITY Are you legally eligible to work in the U.S.? * Yes No Have you ever worked for this employer? * *Yes No *If yes, type the start and end dates: Start Date MM DD YYYY End Date MM DD YYYY Have you ever been convicted of a felony or incarcerated within the past 5 years? * *Yes No *If yes, please explain: Are you over the age of 18 years? * Yes *No *(If no, you may be required to provide authorization to work.) III. EDUCATION High School * [Name] Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Graduate? * Yes No Diploma Type (Choose One) Not Applicable General Diploma Honors Diploma Occupational Diploma Graduate Equivalency Degree College Address Address 1 Address 2 City State/Province Zip/Postal Code Country Graduate? Yes No Degree Type (Choose One) Not Applicable Associate Degree Bachelor's Degree Master's Degree Doctoral Degree Other Education Website http:// Address Address 1 Address 2 City State/Province Zip/Postal Code Country Start Date MM DD YYYY End Date MM DD YYYY Degree / Certification (Describe) IV. PREVIOUS EMPLOYMENT (Start with your current or most recent position.) Employer #1 Email Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Start Pay Check One Hourly Salary End Pay Check One Hourly Salary Job Title Responsibilities Describe: Start Date MM DD YYYY End Date MM DD YYYY Reason for Leaving Employer #2 Email Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Start Pay Check One Hourly Salary End Pay Check One Hourly Salary Job Title Responsibilties Describe: Start Date MM DD YYYY End Date MM DD YYYY Reason for Leaving Employer #3 Email Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Start Pay Check One Hourly Salary End Pay Check One Hourly Salary Job Title Responsibilities Describe: Start Date MM DD YYYY End Date MM DD YYYY Reason for Leaving Have you completed any courses, seminars and/or training directly related to the position for which you are applying? *Yes No *If yes, please explain: List any certifications you may have: V. GIVE THREE REFERENCES (Not Relatives) Reference #1 * First Name Last Name Relationship * Company * Title * Email * Phone * (###) ### #### Reference #2 * First Name Last Name Relationship * Company * Title * Email * Phone * (###) ### #### Reference #3 * First Name Last Name Relationship * Company * Title * Email * Phone * (###) ### #### VI. MILITARY SERVICE Are you a veteran? * Yes No Branch (Choose One) Not Applicable Army Marine Corps Navy Air Force Space Force Coast Guard Rank at Discharge (Choose One) Not Applicable Lieutenant General Officer Colonel Admiral Major Captain Lieutenant Colonel Major General Type of Discharge (Choose One) Not Applicable Honorable Discharge General Discharge Medical Discharge Bad Conduct Discharge Under Other Than Honorable Conditions Entry-Level Separation Dishonorable Discharge Dismissal (Officer Discharge) If not honorable, please explain: VII. BACKGROUND CHECK CONSENT If asked, are you willing to consent to a background check? * Yes No VIII. DISCLAIMER Applicant understands that this is an Equal Opportunity Employer and is committed to excellence through diversity. Please complete each section EVEN IF you decide to send a resume. I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated. * I Understand & Agree I Disagree Thank you!
