Elmwood Employee Application
First Name *
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Last Name *
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E-mail Address *
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Street Address
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City
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State
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Zip Code
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Phone
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Desired Position *
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What Shift Can You Work?
Please choose from the facilities listed below for which you would like to be considered *
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Have you lived in Ohio continuously for the past 5 years *
Do you have any training for the position for which you are applying *
Are you related to anyone employed by Elmwood
Can you physically and mentally perform the essential functions of the job for which you are applying
Do you need reasonable accommodation to be able to perform the job function
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Do you hold any professional licenses or certifications
Education
Education - Name and Location of School
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Did you graduate
Degree or Certification
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Education - Name and Location of School
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Did you graduate
Degree or Certification
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Education - Name and Location of School
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Did you graduate
Degree or Certification
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Former Employers / Work Experience
Company Name and Address
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Job Title
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Date From
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Date To
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Wage
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Reason for Leaving
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Company Name and Address
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Job Title
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Date From
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Date To
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Wage
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Reason for Leaving
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Company Name and Address
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Job Title
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Date From
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Date To
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Wage
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Reason for Leaving
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Equal Opportunity Employer
Elmwood is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, sex, age, military status or handicap. Elmwood shall also make reasonable accommodation according to ADA Guidelines for those who qualify. By affixing my signature below, I understand that I will have to successfully pass a physical examination, TB testing, and random drug testing after the offer to hire. I also agree that if employed, I will serve to the best of my ability and will abide by the policies established by Elmwood. I understand that Elmwood operates as an "employment at will" company. I authorize the former employers/individuals listed above to release all information concerning my prior employment. I also authorize Elmwood to conduct a criminal background check and an FBI check, if applicable, and understand that I have not been convicted of any felony offenses and understand that my employment may be terminated if I have been convicted of a prohibited crime unless I meet personal character standards set by the Director of the Department of Health as an exception to the prohibition on employment. I understand that it is my responsibility to notify Elmwood within 14 days if I am ever convicted of a felony or any of the disqualifying offenses during my employment. I understand that an FBI check is required unless I have lived the prior five years in the state of Ohio. By affixing my signature below, this shall be considered an affidavit that I have answered the residency question and all other questions on this application correctly. Further, I hold the parties and Elmwood harmless from any consequences arising from such release.
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