Application For Employment Pride & Joy Support Services LLC is an equal opportunity employer. Pride & Joy does not discriminate in employment concerning race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status, or unfavorable discharge from military service or any other characteristic protected by law. By initialing below, the applicant is attesting to having no previous convictions for the disqualifying offenses listed in OAC 5123:2-2-02 and attests you will notify Pride & Joy Support Services LLC within 14 days if ever charged with or plead guilty to a disqualifying offense as listed in OAC 5123:2-2-02. Required Field* Initials:* Upload your resume* PERSONAL INFORMATION Incomplete information could disqualify you from further consideration. Please complete all fields. Name* Date of Birth* Address* E-mail Address* Social Security #* Driver License #* Expiration* Home phone #* Mobile phone #* Are you eligible to work in the U.S?YesNo Are you at least 18 years or older? (If no, you may be required to provide authorization to work.) YesNo Have you ever been terminated from employment or asked to resign by an employer? YesNo If yes, please provide company names and details EMPLOYMENT DESIRED Date you can start Hourly rate/Salary desired Position desired* Are you currently employed?YesNo If so, may we inquire with your present employer?YesNoN/A Can you perform the job’s essential functions for which you are applying, with or without reasonable accommodation?YesNo REFERRAL SOURCE How did you hear about us?Walk-inAdvertisementReferralOther Have you ever worked for this (company name) before?YesNo If Yes, explain Do you know anyone who works for our company?YesNo If Yes, Who EDUCATION Education*High SchoolCollege or UniversityTrade, BusinessCorrespondence Name and location of schools* Degree Received* Subjects studied/Major* CERTIFICATIONS CPRYesNo First aidYesNo Med-Cert CertificationsYesNo List Med-Cert CertificationsMed-Cert 1Med-Cert 2Med-Cert 3 EMPLOYMENT HISTORY Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backward in time. Incomplete information could disqualify you from further consideration. Employer Name* Start date* End date* Job Title* Address Telephone Supervisor and title Summarize the nature of work performed and job responsibilities Reason for leaving Employer Name Start date End date Job Title Address Telephone Supervisor and title Summarize the nature of work performed and job responsibilities Reason for leaving Employer Name Start date End date Job Title Address Telephone Supervisor and title Summarize the nature of work performed and job responsibilities Reason for leaving Do you have any special skills, experience, and training that would enhance your ability to perform the position applied for?YesNo If Yes, explain REFERENCES Name three persons not related to you, whom you have known for at least three (3) years. Name* Address, Phone, Email Company Years Acquainted* Name* Address, Phone, Email Company Years Acquainted* Name* Address, Phone, Email Company Years Acquainted* EMERGENCY CONTACT INFORMATION Name* Address* Phone Number* AVAILABILITY Availability to work*MondayTuesdayWednesdayThursdayFridaySaturdaySunday DESIRED SCHEDULE 1st ShiftMondayTuesdayWednesdayThursdayFridaySaturdaySunday 2nd ShiftMondayTuesdayWednesdayThursdayFridaySaturdaySunday 3rd ShiftMondayTuesdayWednesdayThursdayFridaySaturdaySunday Can you work any shift? YesNo If No, explain Can you work overtime, including weekends?YesNo Please read carefully before signing. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for [Company Name] to hire me. If I am hired, I understand that either [Company Name] or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of [Company Name] has the authority to make any assurance to the contrary. I attest with my signature below that I have given [Company Name] accurate and complete information on this application. No requested information has been concealed. I authorize [Company Name] to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. Date* Signature* THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE ABOVE.
