HUMAN RESOURCES
(330) 652-9800

 

Cindy Totten,
Human Resource Director
CindyTotten@tcbmrdd.org

 

Dennise Lindsay,
Human Resource Assistant
DenniseLindsay@tcbmrdd.org

 

Kathy Angelo,
Administrative Assistant
KathyAngelo@tcbmrdd.org
FIRST
MIDDLE
LAST
STREET
CITY
STATE
Referral Source
Name of Source
Positions applying for?
Type of employment desired:
Have you ever applied for employment with us before?
If Yes, what position(s)?
Date
Have you ever been employment with us before?
If Yes, what position(s)?
Date
Are you legally eligible for employment in this country?
ADDRESS
NAME
On what date can you be available for work?
Desired Salary Range $
Have you ever been discharged or requested to resign from a position?
If yes, please explain:
Have you ever had a certificate, license or registration revoked or suspended?
If yes, please explain:
Are you 18 years old, or older?
Are you now or have you ever been a member of a State Retirement System of Ohio?
Do you have a current, valid Ohio Drivers License?
Commercial Drivers License?
Have you ever plead guilty to a felony or misdemeanor?
If yes, please provide the dates and details:
(Conviction will not necesarily disqualify an applicant from employment)
Have you ever servedin the U.S. Armed Services?
If yes, what branch?
Discribe Training
ZIP
EMPLOYMENT APPLICATION
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