Devoted Family Care Services
Application for employment
Name
*
First Name
Last Name
Date of birth
*
/
Month
/
Day
Year
Please enter as MM/DD/YYYY
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Do you have a high school diploma or GED?
*
Yes
No
Are you a U.S. citizen?
*
Yes
No
Have you lived in Ohio for the last 5 years?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
If selected for employment are you willing to submit to a pre-employment drug screening test?
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Yes
No
Do you have a DSP certification?
*
Yes
No
Do you have a First aid/CPR certification?
*
Yes
No
What is your work availability? You can pick more than one option just specify in next question.
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Open availability
1st shift (7:30a-3:30p)
2nd shift (3:30p-11:30p)
3rd shift (11:30p-7:30am)
Other
If other, please specify below.
If you are open but prefer a certain shift please specify. If you are not open specify the times you can and cannot be available. Ex Monday - Sunday 12am - 12pm.
Do you have a valid drivers license and reliable transportation, that can support transporting individuals to appointments and community activities.
*
Yes
No
How did you hear about Devoted Family Care Services?
*
Referred by current or former employee
Indeed
Social Media
Job Fair
Other
If your selection was referred or other, please specify below.
If you selected other please specify how you heard of the position. If you were referred by someone please list their name and relationship to you.
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I certify that all answers given herein are true and complete to the best of my knowledge.
*
Initial
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision
*
Initial
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.
*
Initial
Date
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Month
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Day
Year
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