Applying for: Home Manager/Manager in Training (DSP)

Basic Info

First Name: *
Last Name: *
Street Address: *
Email: *
Phone: *
How did you hear about this opening?: *
If other or employee referral, please provide more information:

Address Information

City: *
State: *
Zip Code: *
Street:

Qualifying Questions

Are you authorized to work in the U.S.?: *
Have you ever worked for this company?: *
Are you 21 or older?: *
Do you have a valid OH Drivers License?: *
Is your license in good standing? (4 points or less): *
Do you own a safe, reliable vehicle that can stay with you on shift?: *
Does that vehicle have valid auto insurance on it? (Insurance card has make, model and year of vehicle on it. SR22/FR Bonds not accepted): *
Have you ever been convicted of a misdemeanor or felony (including expunged, closed or juvenile cases)?: *
If Yes, please explain::
Do you speak spanish?: *

Availability

What type of employment are you looking for?: *
Are you able to complete mandatory orientation and training sessions during daytime hours?: *
If offered employment, what day could you start?: *
Which weekend day(s) are you able to work?: *
What shift are you looking to work? Please select all that apply: *

Education - High School

High School: *
Did you graduate?: *

Education - College

College Address:
Did you graduate?::
College:
Degree / Major:

Education - Other

Other Education:
Type:
Other Education Address:

Past Employer #1 - Most Recent

Company _1 - Name:
Company _1 - Address:
Company _1 - Phone:
Company _1 - Job Title:
Company _1 - Supervisor:
Company _1 - Start Date:
Company _1 - End Date:
Company _1 - Starting Wage:
Company _1 - Ending Wage:
Company _1 - Responsibilities:
Company _1 - Reason For Leaving:
Company _1 - May we contact them?:

Past Employer #2

Company _2 - Name:
Company _2 - Address:
Company _2 - Phone:
Company _2 - Supervisor:
Company _2 - Job Title:
Company _2 - Start Date:
Company _2 - End Date:
Company _2 - Starting Wage:
Company _2 - Ending Wage:
Company _2 - Responsibilities:
Company _2 - Reason for Leaving:
Company _2 - May we contact them?:

Past Employer #3

Company _3 - Name:
Company _3 - Address:
Company _3 - Phone:
Company _3 - Supervisor:
Company _3 - Job Title:
Company _3 - Start Date:
Company _3 - End Date:
Company _3 - Starting Wage:
Company _3 - Ending Wage:
Company _3 - Responsibilities:
Company _3 - Reason For Leaving:
Company _3 - May we contact them?:

Job Specific Questions

Do you have supervisory experience?:
If Yes, how many employees have you supervised?:
How many years of experience do you have working with Developmentally Disabled individuals?:
What makes you a good candidate for this position?:

Company Disclaimer & Signature

Read and Accept Company Disclaimer Policy: *
Please submit your authorization and understanding of the Company Disclaimer by typing your full name in the box: *

Attachment Information

Resume:
Attach Resume:
Attach Cover Letter: