Application for Employment - Lake County Board of DD / Deepwood

You can apply for a job by using the online application below or by downloading this fillable PDF (when complete, please email it as an attachment to [email protected] or mail it to the attention of ‘Human Resources Department’ and send to our Administration Building address). Applications are also available at the LCBDD/Deepwood Administration Building located at 8121 Deepwood Boulevard, Mentor, Ohio 44060.

Please specify the job title of the position you are applying for on your application. We look forward to reviewing your job application and thank you for your interest!

The LCBDD/Deepwood does not discriminate on the basis of race, color, national origin, sex religion, age, or disability in employment or the provision of services. Applicants for employment, consideration for promotional opportunities and other aspects of employment will be judged on the basis of an individual’s ability to perform the essential job functions of the position with or without reasonable accommodation. EOE/M/F/D/V

For more information, call (440) 350-5100 or email [email protected].

Your Full Name *

Address*

Phone Number *

Email Address *

Preferred Method of Contact: *
Home PhoneCell Phone

Position Applied for: *
Direct Support ProfessionalAdult ServicesBroadmoor SchoolTransportationMaintenance/CustodialFood ServiceNursingHuman ResourcesInformation TechnologyClericalBusiness Office/FinanceService and Support AdministratorOther

Employment Desired: *
Full-TimePart-TimeSubstituteAny

Have you ever worked for this agency before? *
YesNo

[group app-previousEmploy]

If Yes:
When?
Position Held:
Reason for Leaving:

[/group]

Are you 18 (eighteen) years of age or older? *
YesNo

Are you eligible for work in the United States? *
YesNo

Do you have a Valid State of Ohio Driver’s License? *
YesNo

Do you have a Commercial Driver’s License?*
YesNo

[group app-comLicenseInfo]

If Yes:
Class:
Endorsement:
Expiration Date:

[/group]

Are you related by birth or marriage to any employee or Board member of this agency?*
YesNo

[group app-relationInfo]

If Yes:
Name:
Relationship:

[/group]

Do you have a High School Diploma or GED?*
YesNo

[group app-diplomaInfo]

If Yes:
Name of High School:
Address:
Diploma?YesNo
GED Certification Obtained Through:

[/group]

Have you attended a College or University?*
YesNo

[group app-degreeInfo]

If Yes:
Name of College:
Address:
Years Completed:
Degree:
Major:

[/group]

Do you have any Post Graduate education?*
YesNo

[group app-postGradInfo]

If Yes:
Name of College:
Address:
Years Completed:
Degree:
Major:

[/group]

Have you attended a Business or Trade School?*
YesNo

[group app-tradeInfo]

If Yes:
Name of College:
Address:
Years Completed:
Degree:
Major:

[/group]

Please list employment history with most recent first. Must include phone numbers.

I have Employer Information for ___ previous employers.*
123

[group prevEmployer]

Employer Information (1)

Name of Employer

Phone Number

Address

Status of Employment
Full-TimePart-TimeTemp/Substitute

Job Title

Supervisor's Name

Dates of Employment
to
Salary
to
Duties

Reason for Leaving

[/group]

[group prevEmployer2]

Employer Information (2)

Name of Employer

Phone Number

Address

Status of Employment
Full-TimePart-TimeTemp/Substitute

Job Title

Supervisor's Name

Dates of Employment
to
Salary
to
Duties

Reason for Leaving

[/group]

[group prevEmployer3]

Employer Information (3)

Name of Employer

Phone Number

Address

Status of Employment
Full-TimePart-TimeTemp/Substitute

Job Title

Supervisor's Name

Dates of Employment
to
Salary
to
Duties

Reason for Leaving

[/group]

Certification from the Ohio Department of Education?*
YesNo

[group app-odeInfo]

If Yes:
Type:
Grade:
Area:

[/group]

Certification from the Ohio Department of Developmental Disabilities?*
YesNo

[group app-doddInfo]

If Yes:
Type:
Effective Dates:
to

[/group]

Upload Resume

Work Start Date *

Last 4 Digits of SSN *
XXX - XX -

Weekly Hours Available *

How did you learn of this opening?

Were you referred by a current employee of the Lake County Board of Developmental Disabilities/Deepwood?*
YesNo
[group app-EmployeeReferralInfo]

If Yes:
Employee Name:

[/group]

May we contact your current employer? *
YesNo

Personal Reference - NOTE: Family members are not allowed to be used as personal references.

Personal Reference (1)

Name *

Occupation *

Phone Number *

Personal Reference (2)

Name *

Occupation *

Phone Number *

Personal Reference (3)

Name *

Occupation *

Phone Number *

Other Certification/License/Registration (1)

Type:
Authorizing Board or Agency:
Expiration Date:

Other Certification/License/Registration (2)

Type:
Authorizing Board or Agency:
Expiration Date:

Other Certification/License/Registration (3)

Type:
Authorizing Board or Agency:
Expiration Date:

Additional Information

List any other certification/experiences which you believe would benefit this agency:

I solemnly swear and affirm that I read this employment application in its entirety. The answer to each and every question and any additional statements and/or materials submitted with this application are true and accurate to the best of my knowledge and belief. I understand and agree that the submission of any false and/or misleading statements or the failure to disclose relevant information deemed material to the application process - no matter when discovered - may result in my disqualification for employment or termination of my continued employment, at the discretion of the Board.

I authorize the Board to make whatever inquiries it considers necessary and appropriate of any person or organization to verify any of the information I have provided in this application and to determine my experience, qualifications, skills and abilities. I grant permission for this application and attachments, if any, to be duplicated and distributed to Board employees responsible for reviewing, interviewing and recommending applicants for employment and to Board employees responsible for personnel records.

I hereby waive all provisions of the law forbidding colleges or universities which I have attended, or past employers, from disclosing any knowledge or information which they thereby acquired relevant to my employment, and I hereby consent to their disclosure of such knowledge or information to the Board, its authorized employees or to the Division of Personnel, Ohio Department of Administrative Services without my prior notice.

I understand that the Board is required by Ohio law to conduct a record check of the criminal conviction history of an applicant under final consideration for employment with the Board. Ohio law and Board policy make applicants with certain criminal conviction histories ineligible for employment. I understand that if requested I will be required to complete an affidavit regarding my criminal conviction history and be fingerprinted. The criminal conviction record check will be conducted by the Ohio Bureau of Criminal Investigation and Identification which may include information from the Federal Bureau of Investigation and, at the Board’s discretion, other state and/or federal agencies. The report of my criminal conviction history, if any, may be made available (Pursuant to Section 5126.28 (c) of the Ohio Revised Code) to Board members, Board employees responsible for employment decisions or any hearing officer in the case of denial of employment. I will be provided with a copy of the report. I understand and agree that my eligibility for employment is subject to and conditioned upon review and evaluation of the criminal conviction history, if any, contained in the report.

I understand and agree that all offers of employment are subject to and conditioned upon the results of a pre-employment physical, including a drug test and tuberculosis test or chest x-ray, verifying my fitness for duty and ability to perform the essential functions of the position with or without reasonable accommodation.

I understand and agree, that as a condition of employment and continued employment, I shall meet and maintain any and all required standards for my position, including but not limited to certification, registration, licensure and/or training. I further understand and agree that in order to renew a certification, registration or licensure, or otherwise as a condition of continued employment, I may be required to enroll in and successfully complete college courses, classes, seminars and/or other job-related training which may be at my expense.

I am prepared to offer documentation of my right to work in the United States.

I have read and attest to the above

Electronic Signature:

Please type your full name in the field above to sign.
Date (Month Day, Year)

Applications must be completed entirely to be considered for employment