EMPLOYMENT APPLICATION


Renaissance House, Inc. is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, national origin, ancestry or age. Application must be completed in entirety to be considered for employment. 

Position Desired:
Schedule Desired:*
Desired Wage:
Date Available:*
The last 4 digits of your Social Security #:*
Phone:*
-
E-mail:

PERSONAL INFORMATION


Name:*
Are you authorized to work in the U.S.?*
Present Street Address:*
How long have you lived there?*
Previous Street Address:*
How long did you live there?*

REQUIREMENTS


A Valid Ohio Driver’s License?*
Personal auto insurance?*
Reliable vehicle to transport individuals?*
A clean driving record (less than 6 points)?*
If no, please list accidents or citations received in past 5 years.

*As part of the employment regulations of Renaissance House Inc. a complete record check will be done through the Bureau of Criminal Identification and Investigation, and the local police department, and possibly the Federal Bureau of Investigation.

Have you ever been convicted of a crime?*
If yes, please explain:

Have you been a resident of Ohio for the past 5 years?*
If not, how long?

EDUCATION


High School Name:*
High School City and State:*
Did you graduate?*

College Name:
College City and State:
Number of Years Attended:
Did you graduate from this college?

Other Education:
Other Education City and State:
Other Years Attended:
Did you graduate from here?

EMPLOYMENT HISTORY

(List employment starting with your most recent position)


May we contact your current employer?*

Employer One Name:
Employment Start Date:
Employment End Date:
Address:
Position Held & Supervisor:
List Duties:
Wages:
Reason for Leaving:

Employer Two Name:
Employment Two - Start Date:
Employment Two - End Date:
Employer Two - Address:
Employer Two - Position Held & Supervisor:
Employer Two - List Duties:
Employer Two - Wages:
Employer Two - Reason for Leaving:

Employer Three Name:
Employment Three - Start Date:
Employment Three - End Date:
Employer Three - Address:
Employer Three - Position Held & Supervisor:
Employer Three - List Duties:
Employer Three - Wages:
Employer Three - Reason for Leaving:

Employer Four Name:
Employment Four - Start Date:
Employment Four - End Date:
Employer Four - Address:
Employer Four - Position Held & Supervisor:
Employer Four - List Duties:
Employer Four - Wages:
Employer Four - Reason for Leaving:


SPECIAL SKILLS


Other skills applicable to position applied for (e.g. CPR, First Aid)::

AVAILABILITY


Willing to work:*

EMERGENCY CONTACT INFORMATION


Emergency Contact 1 Name:
Emergency Contact 1 Address:
Emergency Contact 1 Phone:
-

Emergency Contact 2 Name:
Emergency Contact 2 Address:
Emergency Contact 2 Phone:
-

US MILITARY HISTORY


Branch of Military Services:
Station at the time of discharge:
Highest rank achieved:
Date of Service:
Type of training received:

PERSONAL REFERENCES


Reference 1 Name:
Reference 1 Address:
Reference 1 Phone:
-
Reference 1 E-mail:
Reference 1 Occupation:
Years you've known Reference 1:

Reference 2 Name:
Reference 2 Address:
Reference 2 Phone:
-
Reference 2 E-mail:
Reference 2 Occupation:
Years you've known Reference 2:

Reference 3 Name:
Reference 3 Address:
Reference 3 Phone:
-
Reference 3 E-mail:
Reference 3 Occupation:
Years you've known Reference 3:

MISCELLANEOUS


Check which county you are applying for:

Have you ever been employed by Renaissance House, Inc.?
If "yes," Employment Dates:
If "yes," County:
If "yes," Position Held:

How did you hear about Renaissance House?

APPLICANT INFORMATION


Please read carefully before submitting.

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 misrepresentation may result in denial of employment, or immediate dismissal if employed. By signing this application I am giving Renaissance House, Inc. my consent 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 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