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Employment Application

If you have a question about a job, or about our recruitment and hiring process, please reach out to our Human Resources Manager.

Complete Form

Step 1 of 5

Applicant Information

Hidden

Referring Position

Hidden

Referring Position URL

Name(Required)

First Last

Date(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Date Available(Required)

Desired Salary:(Required)

Position Applied for:(Required)

How did you hear about this opening?(Required)

Are you a citizen of the United States?(Required)

Yes

If no, are you authorized to work in the U.S.?(Required)

Yes

Have you ever worked for BHRC?(Required)

Yes

If yes, when?(Required)

Do you have any relatives who work for BHRC?(Required)

Yes

If yes, please provide the name(Required)

Education

High School

High School(Required)

High School Address(Required)

Street Address Address Line 2 City State ZIP Code

From(Required)

To(Required)

Did you graduate?(Required)

Yes

Diploma

College

College:(Required)

College Address(Required)

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

From(Required)

To(Required)

Did you graduate from College?(Required)

Yes

Degree(Required)

Other

Other:

Address

Street Address Address Line 2 City State ZIP Code

From

Did you graduate (other)?

Yes

Degree:

References

Please list three professional references.

Reference #1

Name(Required)

First Last

Company

Relationship(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Reference #2

Name(Required)

First Last

Company

Relationship(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Reference #3

Name(Required)

First Last

Company

Relationship(Required)

Address

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Military Service

Add Military Service(Required)

Yes

Branch(Required)

Rank at Discharge(Required)

From(Required)

To(Required)

Type of Discharge(Required)

If other than honorable, explain:(Required)

Disclaimer and Signature

Disclaimer

I declare and authorize

I declare that all statements and answers in this application are true and complete in all respects. I acknowledge and agree that any false statement, misleading answer, omission, concealment, or failure to answer any question fully, completely, and accurately will be grounds for refusing to hire me or terminating my employment irrespective of when the information is discovered.

I authorize Buckeye Hills Regional Council or any of its agents, at any time prior to or during my employment, to: a) investigate my references; b) communicate with my former employers; c) conduct an independent investigation of my character, conduct and employment record, including, without limitation, a criminal background check and/or request a credit report and/or request an investigative background credit report. I understand that the results of the investigation, the investigative consumer report or background checks may be kept and preserved. Additionally, I release all parties from all liability for any damage that may result from furnishing information to Buckeye Hills Regional Council or its agent. I further acknowledge that a telephone facsimile (FAX) or photographic copy of this release form shall be valid as the original. According to the Fair Credit Reporting Act (FCRA), I am entitled to know if employment is denied because of information obtained by my perspective employer from a consumer-reporting agency.

In consideration for my employment, I agree to abide by the rules and regulations of Buckeye Hills Regional Council, whose rules may be changed, withdrawn, added or interpreted at any time, at the Organization's sole option and without prior notice to me.

I understand that all employees of the Organization are employees at will and that if employed, my employment with the Organization may be terminated at any time with or without reason or notice. Nothing contained in documentation provided to me as an employee is intended to limit, modify, change, or amend the at will nature of employment with the Organization. Any salary figures provided to an employee in annual or monthly terms are stated for the sake of convenience or to facilitate comparisons and are not intended and do not create an employment contract for any specific period of time.

Digital Signature(Required)

First Name Last Name

Date(Required)

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Employment Application

Applicant Information

Education

High School

College

Other

References

Reference #1

Reference #2

Reference #3

Previous Employment (up to three)

Company #1

Company #2

Company #3

Military Service

Disclaimer and Signature

Older Adults & Caregivers

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Community Leaders

Need funding for a project in your community?

Are you a service provider?

Employment Application

Applicant Information

Education

High School

College

Other

References

Reference #1

Reference #2

Reference #3

Previous Employment (up to three)

Company #1

Company #2

Company #3

Military Service

Disclaimer and Signature

Advice Line

Older Adults & Caregivers

Need immediate help for yourself or a loved one?

Community Leaders

Need funding for a project in your community?

Are you a service provider?