Apply Online Fill Out the Form Below to Apply for a Position at Buckeye Residential Solutions First Name*Middle NameLast Name*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Position Applied For* Full-Time Residential Specialist Part-Time Residential SpecialistLocation Applied For*Ravenna, OhioToledo, OhioRate of Pay Expected*Date You Can Start Date Format: MM slash DD slash YYYY Are you legally eligible for employment in the USA?*YesNo(Verification will be required by law)Are you currently employed?*YesNoMay we contact your employer?*Prior EmploymentMost recent previous employment.EmployerPositionAddressEmployer PhoneSalary/WageSupervisor NameFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Reason For LeavingPrior EmploymentSecond most recent previous employment.EmployerPositionAddressEmployer PhoneSalary/WageSupervisor NameFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Reason For LeavingEducationHigh SchoolYears Attended*Post High SchoolYears Attended*Did you graduate from high school or receive a GED?*High School GraduateGEDMiscellaneous1. You will be required to attend all new staff training including orientation, MUI, OSHA, HIPPA, CPR, First Aid and Medication Administration training. These classes are offered during normal business hours, 9am-5pm, Monday thru Friday. Are you able to attend?YesNo2. Some sites require lifting, transferring consumers and use of a Hoyer lift. Are you able to perform all of these job functions?YesNo3. Are you comfortable working at a site with pets?YesNo4. Are you willing to work at a site where the consumer smokes?YesNo5.a. Have you ever been convicted of or pleaded guilty to a felony contained in the Ohio Revised Code:YesNo5.b. Have you ever been convicted of or pleaded guilty to a crime contained in the Ohio Revised Code constituting a misdemeanor of the first degree on the first offense and a felony on subsequent offenses.YesNo5.c. Have you ever been convicted of or pleaded guilty to a violation of an existing or former law of Ohio, and other state, or the United States, which offense is substantially equivalent to any of the offenses described in (A) or (B) above.YesNo6. Have you ever been discharged or requested to resign from a position?YesNo7. Have you ever had a certificate, license or registration revoked or suspended?YesNo8. Can you perform the job-related requirements of the specific job(s) for which you are applyingYesNoI CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE AND UNDERSTAND THAT IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISSMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED TO GIVE YOU, ANY, AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITIES FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING THEM TO YOUI UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS “AT WILL” AND FOUR CORNERS CLEANING INC RESERVES THE RIGHT TO TERMINATE ME AT ANY TIME
