Application for Employment

“In keeping with our United Methodist tradition, we seek to
enhance the quality of life and holistic growth of older persons.”

Certified Signature and Information Release

I hereby certify that the statements contained in this application or other documents submitted and the statements made during any interview process are true and complete to the best of my knowledge, and I understand that material omissions from or false statements made in this application or other documents submitted or occurring during any interview process shall be grounds for denial of employment or discharge.

I also voluntarily consent and submit to, and authorize Otterbein Homes through a physician chosen by it, to conduct a post-employment offer and future physical and medical examinations including drug and alcohol screening tests and that failure to pass such test(s)in whole or in part will be grounds for denial of employment or termination if employed at the time.

I understand that state law, AM Sub. S.B. 160, requires candidates who receive final consideration for certain positions in nursing homes, residential care facilities, homes for the aging, skilled nursing facilities and similar agencies to undergo a criminal record check and that individuals who have been convicted or pleaded guilty to prohibited offenses specified in the law, AM Sub. S.B. 160, may be disqualified for employment in covered agencies. Should I receive final consideration for employment, I consent and voluntarily submit to providing fingerprint impressions, a valid “certificate of no record” and other information which may be required to determine my eligibility for employment under AM Sub. S.B. 160.

I understand and agree that nothing stated in this employment application, in any other document, or in any interview is intended to create an employment contract between Otterbein Homes and myself for either employment or for providing any benefit. Likewise, no such contracts are intended to be created from the mere granting of an interview. No promises or guarantees regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Otterbein unless made in writing by the President/CEO and then only for the time specified or, is none is specified, for one week.

I understand and agree that if I am hired, my employment is for no definite period of time. I further understand and agree that, regardless of the date of the payment of wages, salary or benefits, my employment, including wages, salary or benefits may be terminated with or without cause and with or without notice at any time by Otterbein Homes. In addition, I understand that I likewise may terminate my employment with or without cause and with or without notice at any time.

I Understand and Agree
(box must be checked for consideration)

To Whom It May Concern:

I authorize and request each former employer and each person, firm or corporation which I have given as a reference; each school, college, or university which I have indicated that I attended; all local, municipal, city, county, state, and federal law enforcement authorities to furnish any information that may be sought by Otterbein concerning me; and I hereby release all parties from any liability for any damage that may result from furnishing any such information and waive any privileges involved.

 I Authorize Information to be Obtained
(box must be checked for consideration)


Please list any other names that records may be listed under
(maiden name, etc.)


Otterbein Homes is an equal opportunity employer


Received by:

Date:

*** ATTENTION…..PLEASE READ BEFORE FILLING OUT APPLICATION ***

The following is the Partners in Caring Mission Statement and Standards of Behavior for Otterbein Retirement Living Communities. If you feel that you can follow this standard, please fill out this application. If you feel that this standard is not something you wish to abide by, you may not want to work for Otterbein and might wish to seek employment elsewhere.


Partners in Caring Mission Statement and Standards of Behavior

Our partners at Otterbein Retirement Living Communities are dedicated to developing quality relationships with our circle of family, friends and community. In order to live up to our mission, we expect our partners to exhibit the following character traits and standards of behavior.

Honesty
We expect our partners to be honest with others and themselves. We expect that honesty to cover verbal communications, personal property and financial matters. This honesty allows the partners to perform their duties without close supervision.

Dedication and Loyalty
We expect our partners to show dedication by being on time and ready to work. This shows loyalty to teammates, families and community.

Respect
We expect our partners to follow the Golden Rule, “Do unto others as you would have them do unto you.” This must occur in order to receive respect. In other words, you must give respect to get it. When you follow the Golden Rule you show others dignity; compassion; fairness and equality.

Love
We expect our partners to exhibit love by showing to others: patience; kindness; faithfulness; sincerity; a giving attitude; safety; understanding; positive interaction; trust and morality.

Quality
We expect our partners to exhibit a high quality of service in all interactions with our circle of family, friends and community. Established standards of safety will be followed in this pursuit of quality.

Pride
We expect our partners to show pride in their work and obtain the necessary education to uphold these quality standards. This allows the partner to receive independence in job performance.

Attitude
We expect our partners to exhibit a willingness to learn, to work with others and try new ideas. The partner should also exhibit an understanding of teamwork, be motivated in their work, be sincere and friendly to all.

Appearance
We expect our partners to take pride in not only the community’s overall appearance but their own appearance as well. The partner is expected to be groomed and properly attired for their position at all times, following their community’s dress code.

Confidentiality
We expect our partner to maintain confidentiality of residents and staff at all times. This allows residents and staff to maintain their right to privacy.

I have read the Employee Mission Statement and Standards
(box must be checked for consideration)

   
Community:
Name:
Street Address:
City:
State, Zip:
Phone:
   
Position(s) desired:
Shift Preferred:
Are you employed now?
How did you hear about Otterbein?

Do you have any special training , skills, or licensures relevant to the job(s) for which you are applying?

If so, please describe.
   
Did you complete?

* Are you at least 18 years old?

** Are you legally a resident of the U.S.?

*** Have you been convicted of a felony or misdemeanor in the last 5 years? If so please describe.

*** Have you been convicted of a traffic violation in the last 3 years? If so please describe.
   
   
Please List Below Your Last Three (3) Employers Begining With Your Current Employer:
   
Name/Address:
Salary:
Dates of Employment:

May we contact Your Current Employer?
Supervisor:
Description of Work:
Reason for Leaving:
   
Name/Address:
Salary:
Dates of Employment:
May we contact Your Current Employer?
Supervisor:
Description of Work:
Reason for Leaving:
   
Name/Address:
Salary:
Dates of Employment:
May we contact Your Current Employer?
Supervisor:
Description of Work:
Reason for Leaving:
   
Please give name, phone number, and relationship of three (3) persons not related to you, whom you have known for at least one (1) year:
   
Name:
Phone Number:
Relationship:
   
Name:
Phone Number:
Relationship:
   
Name:
Phone Number:
Relationship:

 

* Federal and Stste laws prohibit age discrimination.

** Federal law8 USC S1324 requires that upon hire you produce proof that you are a U.S. citizen or are otherwise authorized by the U.S. Immigration and Naturalization Service to work in the United States.

*** A conviction record will not necessarily be a bar to employment.