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)?
List previous names here:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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?
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?

Employee Referral

Answer all questions below

Rows	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

Other
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.Format: (000) 000-0000.
Job Title
Supervisor name
Hire date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End date (if currently employed put today's date)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for leaving
May we contact?
Employer company name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Job Title
Supervisor name
Hire date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for leaving
May we contact?
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.Format: (000) 000-0000.
Relationship (examples: current/former supervisor, teacher, mentor, etc.)
Years known
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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
For HR Use Only
Does this applicant meet minimum employment eligibility criteria?
Applicant interview scheduled for:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Employment offer made?
First day of orientation scheduled for:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Employment Application

Personal Information

Basic Employment Information

Education

Employment History

Resume

Personal References

For HR Use Only