Employment Application

Employee Application

Please fill out the application below to apply for a position with OAHS.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Social Security Number*
Passing a background check is a requirement for employment. Would you be able to pass one?*
Position Applying For:

DriverDSP - Home and CommunityDSP - Adult Day ServicesProgram ManagerService CoordinatorDirector
Education and Certifications
HS Diploma/GED*
College Degree
Professional Certifications
First Aid Certification *
Current CPR Certification*
MedPass Certification*
Work Availability

	Start	End
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What is the minimum number of hours you will work in one day?*
What is the maximum number of hours you will work in one day?*
Residency and Licenses
Lived in Ohio for the last 5 years?*
If no, please provide the previous prior address within the last five (5) years.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Year From
Year To
Please provide any additional prior address within the last five (5) years.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Year From
Year To
Would you be willing to transport clients using your personal vehicle?*
Do you have a valid driver's license?*
Do you have vehicle insurance?*
Which State are you licensed in?*
Please put N/A if you do not have a license.
Driver's license number?*
Please put N/A if you do not have a license.
Skills

Knowledge, Skills, and Abilities

	Beginner	Developing	Proficient	Advanced
Adaptability, Flexibility, and Patience
Attention to Detail
Collaboration and Teamwork
Compassion and Empathy
Conflict Management and Problem-solving
Coaching and Motivating
Communication
Critical Thinking
Documentation and Systems
Interpersonal Skills
Leadership
Managing and Supervising
Organization and Planning
Teaching and Leading Groups
Technology and Computer Literacy
Time Management, Reliability, and Work Ethic

Areas and Level of Experience

	Entry-Level	Mid-Level	Manager-Level	Senior-Level
Administrative and Office Management
Art and Design
Automotive and Mechanics
Behavior Supports
Business Administration
Caregiving, Health Services, and Case Management
Computers and Information Technology
Custodial, Building Maintenance, and Landscaping
Education and Training
Entertainment and Sports
Finances and Training
Food Prep and Service
Human Resources
Management and Business Operations
Retail, Sales, and Customer Service
Transportation Services

References
Professional Reference Company*
Professional Reference Relationship*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Professional Reference Company*
Professional Reference Relationship*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Personal Reference Relationship*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please take a moment and tell us a little more about your skill sets, professional certification, and/or experience.*
Applicant Acknowledgment
I certify that, to the best of my knowledge, the answers given are true and complete and that purposeful misrepresentation may result in the rejection of my application. I authorize investigation of all statements contained in this application, as required. Additionally, I authorize former employers, references, and any other individual or organizations to provide information to Open Arms Health Systems LLC, and I hereby release Open Arms Health Systems LLC from any liability of any kind based on the aforementioned information. I also understand that it is my responsibility to keep such information current and accurate by updating it as often as necessary.

I agree to a physical examination, if requested, and understand that failure to meet any medical and/or health requirements for the position may prevent my employment with the agency. I also understand that employment for certain positions may be conditional upon successful completion of a substance abuse screening test if part of the Agency’s pre-employment policy.

I understand that, if hired, I may be required to provide proof that I am a citizen of the United States or proof that I am currently authorized to work in the United States. I further understand that the information contained on my application will be used to complete background checks as required by federal and state laws. I may also be required to provide proof of education and/or other documents necessary for employment, as required by the Agency and other governing authorities.
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Equal Opportunity Employer

Open Arms Health Systems is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of age, color, gender expression, gender identity, national origin, non-disqualifying physical or mental disability, race, religion, sex, sexual orientation, veteran status, or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.
Should be Empty:

Employee Application

Education and Certifications

Work Availability

Residency and Licenses

Skills

References

Applicant Acknowledgment