Apply Online at Buckeye Residential

First Name*

Middle Name

Last Name*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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

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?*

Prior Employment

Most recent previous employment.

Employer

Position

Address

Employer Phone

Salary/Wage

Supervisor Name

From

To

Reason For Leaving

Prior Employment

Second most recent previous employment.

Employer

Position

Address

Employer Phone

Salary/Wage

Supervisor Name

From

To

Reason For Leaving

Education

High School

Years Attended*

Post High School

Years Attended*

Did you graduate from high school or receive a GED?*

High School Graduate
GED

Miscellaneous

1. 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 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

Apply Online

Fill Out the Form Below to Apply for a Position at Buckeye Residential Solutions

Prior Employment

Prior Employment

Education

Miscellaneous