Employment application

Applicants for employment with Ashtabula County Nursing and Rehabilitation Center are evaluated and selected on the basis of individual merit and ability with respect to the position being filled. Applicants are selected and hired without discrimination based on race, color, religion, sex, age, national origin, political affiliation, disability or ancestry. Fingerprinting and criminal records check will be conducted on all applicants under final consideration for a position with the Ashtabula County Nursing and Rehabilitation Center. Applicants my request reasonable accommodation in the application/interview process.

If the job posting listed a driver's license or commercial driver's license as required for the job, please answer the following:

List all previous employment for the last ten (10) years in chronological order - last position first - including U.S. Military. Attach additional pages if needed or resume if desired.

By signing this form, I sent to the submission of a request for a criminal record check as required by Senate ill 160. The request will be submitted by the Ashtabula County Nursing and Rehabilitation Center. I also attest to the following: (1) that I have not been convicted of or pleaded guilty to any of the crimes that would disqualify me from working at the Ashtabula County Nursing and Rehabilitation Center Under S.B. 160; (2) that I understand and agree that if I am found to have a record of any of those crimes, I will not be hired for work at the Ashtabula County Nursing and Rehabilitation Center, or if I have already been hired, my employment will be terminated; and (3) that I was informed that I must provide a set of fingerprint impressions and that a criminal records check must be conducted if I come under final consideration for employment. I certify that all information contained in this application is true, complete and correct to the best of my knowledge. I understand that any material omission, misrepresentation of falsification of this information for grounds for dismissal from or refusal of employment. I hereby authorize the investigation of all statement contained in this application and giver permission to contact all or any of my previous employers, references and/or schools for information unless otherwise noted in this document. I also give my consent to contact the Bureau of Motor Vehicle Violation Report if such information is required to perform the duties of the position. I indemnify and hold all persons either providing or receiving information, verbal or written, pursuant to this application.