Wynn-Reeth - Online Employment Application

Name  SS # 
Address  City   State   Zip 
Phone
Position Desired  Shift(s) Desired 
Have you lived in Ohio continuously for the past 5 years? 
Do you have any training for the position(s) for which you are applying? 
Are you related to anyone in our employ?   If yes, who? 
Can you physically and/or 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? 
Do you hold any professional licenses or certifications? If so, please list: 
Have you ever applied for a position with this agency in the past? 


EDUCATION
Name/Location Did you graduate? What degree? Attended from: to:


PAST EMPLOYMENT
Name/Address Title Begin date End date Wage Reason for Leaving


If employed, in case of emergency, please notify:
Name Relationship to you
Address Telephone Number


Wynn-Reeth, Inc. is an equal opportunity employer and shall not take any action regarding employment that is discriminatory on the basis of race, color, national origin, religion, sex, age or handicap. Wynn-Reeth, Inc. 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 the Board of Directors. I understand that Wynn-Reeth, Inc. 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 Wynn-Reeth, Inc. to conduct a criminal background check and an FBI check, if applicable, 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 or ODMR/DD as an exception five years in the sta te 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 to the prohibition on employment. I understand that an FBI check is required unless I have lived the prior 5 years in Ohio. I further hold Wynn-Reeth, Inc. harmless from any consequences arising from such release. This signature also guarantees that I have not been convicted of or pleaded guilty to any of the offenses as listed on the reverse side of this application and that I will notify the employer within 14 days if I should be formally charged with, convicted of or plead guilty to any of the disqualifying events. I will also give notice within 14 days in the event that my driver’s license is revoked or suspended.

PROFESSIONAL REFERENCES (PLEASE PROVIDE 2)
Name/Title Company Contact Information


COMMUNITY REFERENCES (PLEASE PROVIDE AT LEAST 1)
Name How does this person know you? Contact Information


Please note that this agency is not permitted to employ any person that has been convicted of or pleaded guilty to any of the following:
2903.01 Aggravated Murder 2907.32 Pandering Obscenity
2903.02 Murder 2907.321 Pandering Obscenity Involving a Minor
2903.03 Voluntary Manslaughter 2907.322 Pandering Sexually Oriented Matter..
2903.04 Involuntary Manslaughter 2907.323 Illegal Use of Minor in Nudity-Oriented Material
2903.11 Felonious Assault 2911.01 Aggravated Robbery
2903.12 Aggravated Assault 2911.02 Robbery
2903.13 Assault 2911.11 Aggravated Burglary
2903.16 Failing to provide for Functionally Impaired Person 2911.12 Burglary
2903.21 Aggravated Menacing 2919.12 Unlawful Abortion
2903.34 Patient Abuse and Neglect 2919.22 Endangering Children
2905.01 Kidnapping 2919.24 Contributing to Unruliness or delinquency of ...
2905.02 Abduction 2919.25 Domestic Violence
2905.05 Criminal Child Enticement 2923.12 Carrying Concealed Weapon
2907.02 Rape 2923.13 Having Weapons While Under Disability
2907.03 Sexual Battery 2923.161 Improperly Discharging Firearm ...
2907.04 Unlawful Sexual Conduct w/a Minor 2925.02 Corrupting Another with Drugs
2907.05 Gross Sexual Imposition 2925.03 Trafficking in Drugs
2907.06 Sexual Imposition 2925.04 Illegal Manufacture of Drugs or Cultivation ...
2907.07 Importuning 2925.05 Funding of Drug Trafficking
2907.08 Voyeurism 2925.06 Illegal Administration or Distribution of Steroids
2907.09 Public Indecency 3716.11 Placing Harmful Objects in Food or Confection
2907.21 Compelling Prostitution 2905.04 Child Stealing
2907.22 Promoting Prostitution 2919.23 Interference with Custody
2907.23 Procuring 2925.11 Possession of Drugs
2907.25 Prostitution 2907.12 Felonious Sexual Penetration
2907.31 Disseminating Matter Harmful to Juveniles 5123.28 Patient Endangerment