Cleveland Hearing & Speech Center (CHSC) is an equal opportunity employer with a long-standing record of non-discrimination in employment. CHSC selects the best qualified individual for the job based on job-related qualifications regardless of race, color, religion, creed, national origin, ancestry, disability, sex or age.
NOTE: If your resume contains previous employer and education information, you may skip those portions of the application.
Please attach resume file here:
Please attach cover letter file here:
Name: *
Address: *
Home Phone: *
Cell Number: *
Email: *
Job you are applying for: *
Date you can start:
Salary desired:
1. The law requires that you provide proof of your legal right to live and work in this country. If you are hired, can you provide proof of U.S. citizenship or legal eligibility for employment in the U.S.? *
2. Are you at least 18 years old? If no, please enter date of birth: *
3. Have you ever been convicted of a crime, pled guilty or been released from prison? If yes, please use the next section to explain including date, place and nature of offense(s). * NOTE: Conviction of a crime or a criminal record will not automatically bar you from employment – all circumstances will be considered.
4. Are you able to perform the essential functions of the position you are applying for, either with or without an accommodation? *
Have you ever served in the United States Armed Forces? *
If you are currently employed, may we contact your employer?
Have you ever applied or worked with CHSC before?
Female Male Nonbinary Prefer not to respond Do you consider yourself to be an ethnic or racial minority?
- Yes
- No
- Prefer not to respond
Would you consider yourself a Person with Disabilities?
- No
- Yes
- Prefer Not to Respond
Previous Employment Information
NOTE: If you have a resume that contains the information requested below, it is not necessary for you to complete this portion of the application.
Name and address of employer:
Job Title and Duties/Responsibilities:
Beginning Date:
Ending Date:
Name and address of employer:
Job Title and Duties/Responsibilities:
Beginning Date:
Ending Date:
Name and address of employer:
Job Title and Duties/Responsibilities:
Beginning Date:
Ending Date:
Previous Education Information
NOTE: If you have a resume that contains the information requested below, it is not necessary for you to complete this portion of the application. Please skip down to the section labeled, " Alcohol, Controlled Substance and Physical Examination."
High School Information
Name and address of high school:
Major:
Grade Point Average:
Degree Earned:
Undergraduate College or Technical School Information
Name and address of undergraduate college or technical school:
Major:
Graduation Date:
Grade Point Average:
Degree earned:
Undergraduate College or Technical School Information
Name and address of undergraduate college or technical school:
Major:
Graduation Date:
Grade Point Average:
Degree Earned:
Graduate School Information
Name and address of graduate school:
Major:
Graduation Date:
Grade Point Average:
Degree Earned:
Additional training, seminars, skills, foreign languages, abilities, volunteer experience, special achievements, certifications, licenses, etc. relative to the job you are applying for:
How did you learn about this job?
Alcohol, Controlled Substance and Physical Examination
CHSC retains the right to insist on a drug and alcohol free environment in order to ensure employee safety, a high level of productivity and to reduce absenteeism. I understand that at any time after I am hired, CHSC may require me to submit to, and disclose to CHSC the results of, fair and reasonable tests whenever:
- CHSC has reasonable cause to suspect that an employee’s work performance or attendance is negatively affected by the employee’s use of alcohol or any controlled substance;
- the employee is observed using a controlled substance while conducting business on behalf of CHSC;
- the employee is undergoing or has recently completed treatment for alcohol or controlled substance dependency as part of a post-treatment employment agreement.
I understand that an offer of employment from CHSC may be made contingent on my passing a job-related physical examination that includes testing for the presence of controlled substances and/or obtaining body tissue or fluid samples and analysis of them. I have read, understand and agree to this information.
If hired, your signature below constitutes your agreement to the following: All employment by CHSC is “at will” under the laws of the state of Ohio. This means that your employment with CHSC is not for any express or implied duration and can be terminated with or without cause, and with or without notice at any time, at the option of either CHSC or yourself. Because neither you nor CHSC has entered into any implied or express contract of employment for a given period of time and your employment is voluntary, you are free to resign at any time. In turn, the organization may terminate your employment, at its sole discretion, with or without cause at any time.
Additionally, your signature below constitutes your certification that all the information provided by you on this application for employment is complete and correct to the best of your knowledge. You authorize CHSC to verify the accuracy of all information you have provided herein. Your signature further constitutes your authorization for CHSC to investigate the facts submitted and for those with relevant information, including, but without limitation, physicians, hospitals, schools, law enforcement agencies and any prior employers, to provide such information to CHSC, and you release them from any liability for doing so. Furthermore, you understand that any falsification of information on this application is grounds for non-selection, or for termination from employment if you are hired, regardless of time of discovery. Upon your acceptance of employment, you agree to abide by all applicable CHSC rules, regulations and policies.
If you have any questions regarding the above Alcohol, Controlled Substance andPhysical Examination Information, please contact the office before your final interview.
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