Applicant First Name

Last Name

Middle Initial

Phone

Email

Applicant Address

Street Address Address Line 2 City State ZIP Code

Application Today's Date

Date Available to Start

Are you currently certified in CPR?

Yes
No

Are you currently certified in First Aid?

Yes
No

Do you hold a current State Medication Administration Certificate?

Yes
No

Have you ever applied for or worked for WLRS in the past?

Yes
No

Have you ever been convicted of or plead guilty to a felony?

Yes
No

If yes explain

If selected for employment, could you present evidence of your U.S. citizenship or proof of legal rights to live and work in this country?

Yes
No

Are you a High School Graduate or have passed the GED Exam?

Yes
No

Have you resided in Ohio for the past 5 years?

Yes
No

Employment Desired (choose all that apply)

Full time (70 to 80 hours bi-weekly)
Part-Time (Minimum 24 hours bi-weekly)
First Shifts between 6AM-4PM
Second Shifts between 2PM-12AM
Third Shifts between 10PM-9AM

Position Desired (choose all that apply)

Consumer Services Professional
Direct Support Professional (DSP)
Direct Support Professional (DSP) - Third Shift
Home Supervisor
Qualified Intellectual Disability Professional (QIDP)
Shuttle Driver
Day Hab Professional

All positions other than those designated non-drive will require some driving (i.e. take individuals shopping, to work, etc). Please check the applicable box below after reviewing the following requirements. The requirements for a driving position are: 1. At least 21 years of age. 2. Have valid driver's license in effect for at least 3 years AND maximum of 1 minor moving violation in the last 3 years in combination with 1 at fault accident OR maximum of 2 minor moving violations in the last 3 years with no at fault accidents OR maximum of 2 at fault accidents in the last 3 years with no moving violations; no speeding over 25 miles per hour or more over the posted speed limit.

Driving Position- I meet the above insurability criteria

Yes
No

Most positions at WLRS require working Holidays and weekends on occasion. Are you able to work during these times?

Yes
No

How did you hear about the position (choose all that apply)

Friend/Family
Google
Facebook or Social Media
WLRS Website
Employee Referral
Job Fair
Other

If Employee Referral Selected, Please type Employee Name

Other

Please list all present and past employment, starting with your most recent or current employer. Please include any military service as emploment and Thank You for your service to those who have served. Please complete this section even if you plan on attaching a resume to this application. Please attach a current resume. Any incomplete information will prevent us from processing your application. We will also be conducting a thorough reference check before offering any position.

1 Current or Most Recent Employer

May we contact your previous supervisor?

Yes
No

Position?

Start Date

End Date

Current or Ending Salary

Please share employer contact information and/or description of duties.

2 Previous Employer

May we contact your previous supervisor?

Yes
No

Position?

Start Date

End Date

Current or Ending Salary

Please share employer contact information and/or description of duties.

3 Previous Employer

May we contact your previous supervisor?

Yes
No

Position?

Start Date

End Date

Current or Ending Salary

Please share employer contact information and/or description of duties.

Attach a Resume

Max. file size: 10 MB.

By clicking submit below, I certify that the information I have provided in this application is true and complete to the best of my knowledge. I understand that if this application is not fully completed it will not be processed. I understand that I am responsible for the accuracy of this application. I also understand that a background check will be required prior to employment and in accordance with the Drug Free Work Place Procedure applicable drug testing requirements must be met. I waive all provisions of law forbidding colleges and universities for which I have attended or past employers from disclosing information to the Human Resource Department of the agency that holds the vacancy for which I am applying and to appropriate officials for recruitment purposes. I understand that any offer of employment is conditional upon completion of all pre-employment requirements.

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Compassion. That’s the common attribute of those that work for WLRS.

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