Careers

Employment Listings

Download the FORM or Fill out the FORM Below:

Name *

First

Last

Date *

dd/mm/yyyy

Address *

City *

State *

Zip *

Email *

Phone *

Position Applied For *

Applying for *

Full Time
Part Time
Contingent
Volunteer

Minimum Salary Requirement *

1. Are you prevented from lawfully becoming employed in this country because of Visa or immigration status? (Proof of identity and employment eligibility will be required upon employment) *

2. Do you drive a car? *

3. Do you have a valid Ohio Driver’s License? *

4. If the position you are applying for requires a certification and/or license, give: Licensing Agency, License No., Date Issued. *

5. May we contact your present employer? *

School Name *

Completed *

Elementary
High School
College/University
Graduate/Professional

Diploma/Degree *

Describe Course of Study *

Describe Specialized Training or Skills *

Background Information - Instructions and important note about the following questions: Please check the proper response for each question below. Answering “yes” on any of the questions below will not disqualify you from consideration for employment. We will consider the date and facts of each event you list. However, if you do not tell the truth or list all relevant events, this failure may be grounds for not hiring you or for termination. When answering these questions, you may omit: 1) any violation of law committed before you 18th birthday, if finally decided in juvenile court or under a youth offender law; 2) any conviction set aside under the Federal Youth Corrections Act or State Law; 3) any conviction whose record was expunged under Federal or State Law; 4) any criminal arrest, investigation or hearing that did not lead or has not lead to a conviction; 5) parking tickets. *

1. Have you ever been convicted of or forfeited bond for any felony? (A felony is defined as any violation of law punishable by imprisonment for one year or more; a misdemeanor is punishable by imprisonment for less than one year.) *

2. Have you been convicted of a misdemeanor of any kind during the last ten (10) years? For purposes of this question, “conviction” includes a plea of no-contest, a find of guilty by a judge or jury as well as a bond forfeiture. (Conviction will not necessarily disqualify an applicant.) *

3. Have you ever been convicted of or forfeited bond for any firearms or explosives violation? *

4. During the past ten (10) years have you forfeited bond, been convicted, been imprisoned, been on probation, or been on parole? Do not include violations reported above. *

5. Do you have accident or moving traffic violations over the past three (3) years? *

6. Are there any charges pending against you by any professional ethics boards, federal or state regulatory agencies, or professional regulatory bodes (example: The American Medical Association) for violations of the law, violations of ethics codes, professional misconduct, incompetence or negligence? *

7. Have you ever had any insurance company decline, cancel or refuse to renew or accept only on special terms any professional liability insurance? Any bonding insurance? *

8. Have you been free of jail time for at least five (5) years? *

If you answered “yes” to any of the above questions, please give in detail the following for each violation: 1) date; 2) charge; 3) place; 4) court; and 5) action taken. *

Previous Employment - Please give accurate and complete employment record. Start with your present or most recent employer. *

Company #1 *

Name of Supervisor *

First

Last

Address *

City *

State *

Zip *

Phone *

Length of Employment *

(mm/yy) - (mm/yy)

Weekly Pay *

Start/Finish

State Job Title & Describe Your Work *

Reason For Leaving *

Company #2 *

Name of Supervisor *

First

Last

Address *

City *

State *

Zip *

Phone *

Length of Employment *

(mm/yy) - (mm/yy)

Weekly Pay *

Start/Finish

State Job Title & Describe Your Work *

Reason For Leaving *

Company #3 *

Name of Supervisor *

First

Last

Address *

City *

State *

Zip *

Phone *

Length of Employment *

(mm/yy) - (mm/yy)

Weekly Pay *

Start/Finish

State Job Title & Describe Your Work *

Reason For Leaving *

Company #4 *

Name of Supervisor *

First

Last

Address *

City *

State *

Zip *

Phone *

Length of Employment *

(mm/yy) - (mm/yy)

Weekly Pay *

Start/Finish

State Job Title & Describe Your Work *

Reason For Leaving *

Professional References - Please fill in the names of three individuals, other than relatives, whom we may contact for a professional recommendation. *

Reference #1 - I hereby authorize *

First

Last

Email *

Phone *

Date *

to disclose any knowledge or information relevant to my employment and I hereby release and discharge the person, firm or corporation which provides information in response to this inquiry from liability and damages of any kind.

Reference #2 - I hereby authorize *

First

Last

Email *

Phone *

Date *

Reference #3 - I hereby authorize *

First

Last

Email *

Phone *

Date *

Optional - Please be advised that The P.E.E.R. Center prefers to employ persons with lived experience with mental illness, addiction and/or trauma. This is inclusive of persons who have used mental health or addiction services now or in the past. The P.E.E.R. Center is asking the questions in this section to further its effort to provide employment to individuals with this shared history. Your answer to any of the following questions is purely optional and no answer will disqualify you from consideration for employment. You may choose not to answer any or all of the following questions. Any responses you provide will remain confidential; will not subject you to any adverse treatment; and will be used in accordance with the Americans with Disabilities Act. This form will be kept separately from the rest of your Employment Application to protect confidentiality. *

1. Are you self identified as a person in recovery (mental health or addiction)? *

2. Have you ever been hospitalized for mental health or substance abuse treatment? *

3. If the answer to number 2 is yes, when were you most recently hospitalized for longer than 72 hours, if ever? *

4. How long have you been clean and sober? *

Name - I understand that answering the questions in this Optional Information section was not required for this employment application. I certify that any answers I may have given in the section are truthful and were voluntarily provided. *

First

Last

Date *

Comment

The PEER Center is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military status.