Employment Application Employment Application Employment Application Policy It is the policy of Renaissance House, Inc. to provide equal opportunity for all persons regardless of race, religious creed, color, national origin, ancestory, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military or veteran status. Application must be completed in entirety to be considered for employment.Personal InformationWhat position are you applying for today? Name* First Middle Initial Last Are you authorized to work in the U.S.?* Yes No Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your Phone NumberYour Email How long have you lived at your current address (in years)?*Please enter a number greater than or equal to 0.Previous Address (if less than 5 years) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long did you live at your previous address (in years)?*RequirementsA Valid Ohio Driver's License?* Yes No Driver's License #* Personal Auto Insurance?* Yes No Reliable vehicle to transport individuals?* Yes No A clean driving record (less than 6 points)?* yes No Driving Record: Please list accidents or citations received in the past 5 years.*Have you ever been convicted of a crime?* Yes No Criminal Convictions: If yes, please explain:*Have you been a resident of Ohio for the past 5 years?* Yes No If not, how long have you been a resident of Ohio?* EducationType of SchoolCheck all that apply. High School College Other Name of High School* High School Address* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State High School: Degree / Area of Study* High School: Number of Years Attended*High School: Graduated* Yes No Name of College* College Address* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State College: Degree / Area of Study* College: Number of Years Attended*College: Graduated* Yes No Name of Other School* Other School: Address* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Other School: Degree / Area of Study* Other School: Number of Years Attended*Other School: Graduated* Yes No Previous EmploymentList your three most recent employers.1. Name of EmployerMost Recent Employer Employer Address (1): City State / Province / Region Employer Phone (1):Position Held (1): Supervisor (1): List of Duties (1):Reason For Leaving (1):Start Date (1)*Enter the start date for this employer MM slash DD slash YYYY End Date (1)*Enter the end date for this employer. Use current date if still employed with this company. MM slash DD slash YYYY 2. Name of Employer2nd most recent, if applicable Employer Address (2): City State / Province / Region Employer Phone (2):Position Held (2): Supervisor (2): List of Duties (2):Reason For Leaving (2):Start Date (2)*Enter the start date for this employer MM slash DD slash YYYY End Date (2)*Enter the end date for this employer. Use current date if still employed with this company. MM slash DD slash YYYY 3. Name of Employer3rd most recent, if applicable Employer Address (3): City State / Province / Region Employer Phone (3):Position Held (3): Supervisor (3): List of Duties (3):Reason For Leaving (3):Start Date (3)*Enter the start date for this employer MM slash DD slash YYYY End Date (3)*Enter the end date for this employer. Use current date if still employed with this company. MM slash DD slash YYYY SkillsSpecial SkillsOther skills applicable to the position applied for (e.g. CPR, First Aid, Medication administration)AvailabilityWilling to work: Evenings Weekends Holidays Overnights Emergency ContactsPrimary Emergency Contact First Last Primary Emergency Contact: Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Emergency Contact: PhoneSecondary Emergency Contact First Last Secondary Emergency Contact: Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Secondary Emergency Contact: PhoneMilitary ServiceDo you have military service?* Yes No Branch of Military Services:* Dates of Service: From* MM slash DD slash YYYY Dates of Service: To* MM slash DD slash YYYY Station at the time of discharge:* Highest rank achieved:* Type of training received:* Personal ReferencesPlease enter three personal references and their contact information.Renaissance HouseWhich county are you applying for? Erie Hancock Huron Sandusky Seneca Have you ever been employed by Renaissance House, Inc.?* Yes No Employment Dates: From* MM slash DD slash YYYY Employment Dates: To* MM slash DD slash YYYY Which county were you employed In?*ErieHancockHuronSanduskySenecaPrevious Position Held* How did you hear about Renaissance House?* Employee Referral Prior Employment Online Job Search Facebook Walk-In ODJFS I certify that all acts contained in this application for employment are true and complete. I acknowledge that Renaissance House, Inc. is relying on the accuracy of this information to determine employment, and understand that any omissions, falsifications, or mispresentation may result in denial of employment, or immediate dismissal if employed. By signing this application I am giving Renaissance House, Inc. my constent to contact all businesses, agencies, and persons that I have listed either as employers, or personal references. I understand that prior to an offer of employment Renaissance House, Inc. will conduct a criminal background check with the Bureau of Criminal Identification and I understand that this is only an application for employment and does not constitute any promise or guarantee of employment on the part of Renaissance House, Inc. or its representatives. I also understand that if employed by Renaissance House, Inc. there is no guarantee of continuous employment, and that my hours may be reduced or terminated due to reductions of needed personnel and/or unsatisfactory work performance.HiddenDisclaimerI certify that all acts contained in this application for employment are true and complete. I acknowledge that Renaissance House, Inc. is relying on the accuracy of this information to determine employment, and understand that any omissions, falsifications, or mispresentation may result in denial of employment, or immediate dismissal if employed. By signing this application I am giving Renaissance House, Inc. my constent to contact all businesses, agencies, and persons that I have listed either as employers, or personal references. I understand that prior to an offer of employment Renaissance House, Inc. will conduct a criminal background check with the Bureau of Criminal Identification and I understand that this is only an application for employment and does not constitute any promise or guarantee of employment on the part of Renaissance House, Inc. or its representatives. I also understand that if employed by Renaissance House, Inc. there is no guarantee of continuous employment, and that my hours may be reduced or terminated due to reductions of needed personnel and/or unsatisfactory work performance.HiddenDate MM slash DD slash YYYY Signature*By typing your full name in the box below, you agree to the terms and conditions of the application and certify that all content is accurate and true to the best of your knowledge.