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Personal Information

Birthday
How did you find out about this position?
Have you resided in Ohio for the past five years?
Yes
No
Are you seeking full-time or part-time employment?
Full-Time
Part-Time
If hired, can you provide proof of citizenship and/or verification of your legal right to work in the United States? *
Yes
No
Were you ever previously employed by Community Supports, Inc. (CSI)? *
Yes
No
Have you ever been convicted of or pled no contest to a felony and/or misdemeanor? *
Yes
No
Have you ever been the subject (PPI) of a Major Unusual Incident (MUI) investigation through Developmental Disability Services or law enforcement?
Yes
No
Do you have a current and valid driver's license?
Yes
No
Do you currently have liability insurance on your vehicle? *
Yes
No
Do you have 5 points or fewer on your driver's license? *
Yes
No

Education

Have you earned your high school diploma or GED? *
Yes
No
Have you earned a degree from a college or university?
Yes
No

Work Experience

Beginning date of employment
Ending date of employment
Beginning date of employment
Ending date of employment
Beginning date of employment
Ending date of employment

References

Is this person a professional or personal reference?
Yes
No

EQUAL OPPORTUNITY EMPLOYER: It is our policy to abide by all Federal, Sate, and local laws prohibiting employment discrimination solely on the basis of a person's race, color, creed, national origin, religion, age (over 40), sex, marital status, sexual preference or physical handicap, except where a reasonable, bona fide occupational qualification exists.

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