Apply Online Fill Out the Form Below to Apply for a Position at Buckeye Residential Solutions First Name* Middle Name Last 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 Specialist Location Applied For* Ravenna, Ohio Toledo, Ohio Rate of Pay Expected* Date You Can Start MM slash DD slash YYYY Are you legally eligible for employment in the USA?* Yes No (Verification will be required by law)Are you currently employed?* Yes No May we contact your employer?* Do you have a valid driver's license?* Yes No Do you have reliable transportation and active insurance?* Yes No Prior EmploymentMost recent previous employment.Employer Position Address Employer PhoneSalary/Wage Supervisor Name From MM slash DD slash YYYY To MM slash DD slash YYYY Reason For Leaving Prior EmploymentSecond most recent previous employment.Employer Position Address Employer PhoneSalary/Wage Supervisor Name From MM slash DD slash YYYY To MM slash DD slash YYYY Reason For Leaving EducationHigh School Years Attended* Post High School Years Attended* Did you graduate from high school or receive a GED?* High School Graduate GED Miscellaneous1. 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? Yes No 2. Some sites require lifting, transferring consumers and use of a Hoyer lift. Are you able to perform all of these job functions? Yes No 3. Are you comfortable working at a site with pets? Yes No 4. Are you willing to work at a site where the consumer smokes? Yes No 5.a. Have you ever been convicted of or pleaded guilty to a felony contained in the Ohio Revised Code: Yes No 5.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. Yes No 5.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. Yes No 6. Have you ever been discharged or requested to resign from a position? Yes No 7. Have you ever had a certificate, license or registration revoked or suspended? Yes No 8. Can you perform the job-related requirements of the specific job(s) for which you are applying Yes No I 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 YOU I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS “AT WILL” AND BUCKEYE RESIDENTIAL SOLUTIONS, LLC RESERVES THE RIGHT TO TERMINATE ME AT ANY TIME.
