Open Door Employment Application

Employment Application
Open Door is an equal opportunity employer. Race, color, religion, age, sex, disability, marital or verteran status, place of national origin, and/or other categories protected by law are not factors in employment, promotion, compensation, or working conditions.
Personal Information

Please complete the following information
Name*

First NameLast NameSuffix
Have you ever gone by any other name (if yes please list below)?*

YesNo
List previous names here:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Driver's License # or State ID # (if you are a non-driver) *
Issuing state for Driver's License or State ID*
Most positions require employees to be vaccinated for COVID-19. Have you been vaccinated against COVID-19?

YesNo
If hired, you will be required to present proof of vaccination prior to your first day of employment.
Basic Employment Information

Please answer the questions below, answers to the questions do not immediately remove the applicant from consideration for employment.
Position applying for*
How did you hear about us?*

Walk inCompany websiteSocial Media (Facebook, Instagram, etc)Job Finder site (LinkedIn, Indeed, etc)Employee Referral

Answer all questions below*

	Yes	No
Have you ever worked for Open Door?
Are you at least 18 years old?
Are you eligible and able to show proof of being able to work in the United States?
Have you lived outside of Ohio in the last five (5) years?
Have you ever been convicted of a crime?
Do you have a valid driver's license (not a temporary permit) with less than six (6) points?
Do you have proof of current car insurance?
Are you willing to work flexible hours including additional hours that are outside of those that you are assigned if/when necessary?

Education

Please mark highest level you have completed
Education level*

GEDHigh School DiplomaAssociates DegreeBachelor's DegreeOther
Employment History

Please list your last two (2) employers starting with your most recent (or current) employer first
Most recent/current employer company name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Job Title*
Supervisor name*
Hire date*

MonthDayYear
Date
End date (if currently employed put today's date)*

MonthDayYear
Date
Reason for leaving*
May we contact?*

YesNo
Employer company name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Job Title *
Supervisor name*
Hire date*

MonthDayYear
Date
End date*

MonthDayYear
Date
Reason for leaving*
May we contact?*

YesNo
Resume

Optional
If you would like to upload your resume, please click "Browse Files" below

Cancelof
Personal References

Complete the information below for two (2) business, school, and/or personal contacts who are not related to you
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship (examples: current/former supervisor, teacher, mentor, etc.)*
Years known*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship (examples: current/former supervisor, teacher, mentor, etc.)*
Years known*
By submitting this form, I certify that the information I provided above is true, complete, and correct to the best of my knowledge. I understand that any information provided by me that is found to be false, incomplete, or misrepresented will be sufficient cause to cancel further consideration of this application and/or discharge me from the employer's service, whenever it is discovered.
Signature

Clear
For HR Use Only
Does this applicant meet minimum employment eligibility criteria?

YesNo
Applicant interview scheduled for:

MonthDayYear
Date
Hour MinutesAM/PM Option
Employment offer made?

YesNo
First day of orientation scheduled for:

MonthDayYear
Date
Should be Empty:

Employment Application

Personal Information

Basic Employment Information

Education

Employment History

Resume

Personal References

For HR Use Only