Helping Hands of Ohio Employment Application

Helping Hands of Ohio Employment Application

Helping Hands of Ohio serves individuals in the DODD field through quality care, dignity, safety, accountability, and excellence. Our mission is to provide compassionate support with professionalism, strong documentation integrity, and a commitment to helping individuals live with dignity and purpose.
Welcome to Helping Hands of Ohio. We are committed to serving individuals in the DODD field with quality care, dignity, safety, accountability, and excellence. We value compassionate support, professionalism, accurate documentation, and helping every individual live with dignity and purpose.
If you arrive for your shift and notice the previous staff person has already initialed medication or documentation for a task that has not happened yet, what would you do?*
If an individual begins escalating, yelling, or refusing support, how would you respond while maintaining safety, dignity, and professionalism?*
If you make a documentation mistake or realize something was not charted correctly, what would you do next?*
Please explain why you left your last 2 jobs and what you learned from those experiences.*
Driving Eligibility Attestation*

I certify
Transportation Liability Acknowledgement*

I agree
Name:*

First NameLast Name
Birth Date

MonthDayYear
Phone Number:*
Format: (000) 000-0000.
E-mail Address:
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

Walk-InEmployeeNewspaper AdFacebookTwitterCraigslistOther (please specify)
Others:
Upload Resume: (Optional)

Cancelof
Job Skills & Training
Describe your skills:*
Training or Certifications:
References Please list two (2) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Name:*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employers

Please list your recent employment history. Add as much detail as possible for each employer.
Employer 1 Name*

First NameLast Name
Employer 1 Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Employer 1 Supervisor Name*

First NameLast Name
Employer 1 Job Title*
Employer 1 Dates Employed Start*

MonthDayYear
Date
Employer 1 Dates Employed End*

MonthDayYear
Date
Employer 1 Main Duties*
Employer 1 Reason for Leaving*
May we contact Employer 1?*

YesNo
Employer 2 Name*

First NameLast Name
Employer 2 Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Employer 2 Supervisor Name*

First NameLast Name
Employer 2 Job Title*
Employer 2 Dates Employed Start*

MonthDayYear
Date
Employer 2 Dates Employed End*

MonthDayYear
Date
Employer 2 Main Duties*
Employer 2 Reason for Leaving*
May we contact Employer 2?*

YesNo
Employer 3 Name*

First NameLast Name
Employer 3 Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 3 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Employer 3 Supervisor Name*

First NameLast Name
Employer 3 Job Title*
Employer 3 Dates Employed Start*

MonthDayYear
Date
Employer 3 Dates Employed End*

MonthDayYear
Date
Employer 3 Main Duties*
Employer 3 Reason for Leaving*
May we contact Employer 3?*

YesNo
References

Professional references are preferred. Relatives are discouraged unless necessary.
Reference 1
Reference 1 Full Name*

First NameLast Name
Reference 1 Relationship*
Reference 1 Company or Organization*
Reference 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Email Address*
example@example.com
Reference 1 Years Known*
Reference 2
Reference 2 Full Name*

First NameLast Name
Reference 2 Relationship*
Reference 2 Company or Organization*
Reference 2 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Email Address*
example@example.com
Reference 2 Years Known*
Reference 3
Reference 3 Full Name*

First NameLast Name
Reference 3 Relationship*
Reference 3 Company or Organization*
Reference 3 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Email Address*
example@example.com
Reference 3 Years Known*
Availability

Please indicate your weekly availability and scheduling preferences.
Sunday Availability*

MorningAfternoonEveningOvernight
Monday Availability*

MorningAfternoonEveningOvernight
Tuesday Availability*

MorningAfternoonEveningOvernight
Wednesday Availability*

MorningAfternoonEveningOvernight
Thursday Availability*

MorningAfternoonEveningOvernight
Friday Availability*

MorningAfternoonEveningOvernight
Saturday Availability*

MorningAfternoonEveningOvernight
Maximum Hours Available Per Week*
Can you work weekends?*

YesNo
Can you work holidays?*

YesNo
Can you accept last-minute shifts?*

YesNo
Recurring Scheduling Restrictions
Should be Empty:

Helping Hands of Ohio Employment Application

Previous Employers

References

Reference 1

Reference 2

Reference 3

Availability