372 E. Center Street P.O. Box 779 Marion, Ohio 43301-0779 Phone (740) 387-1039 Fax (740) 387-8006	Phone: (877) 241-3427 Toll Free Marion Phone: (800) 854-4020 Toll Free Galion Phone: (866) 546-4314 Toll Free Mt. Gilead Phone: (866) 589-4315 Toll Free Mansfield
Samuel J. Buehrer President	Andrew Joseph Devany Executive Director

Instructions Employment Desired Personal Information Current/Previous Employment Education Background Languages References Professional Association Accomplishments Additional Info Affirmative Action Info Affidavit

PLEASE READ THE FOLLOWING BEFORE COMPLETING OUR APPLICATION FOR EMPLOYMENT FORM. Background Checks: Ohio Heartland Community Action Commission is a drug-free employer. Drug testing of both current staff and new hires will be conducted. Employment contingent upon successful completion of licensing requirements, Driver’s Record Check, Criminal Background Check, Drug Test, Employment References, and ODJFS References and Physical if applicable. Job Qualifications: Must respect and maintain absolute confidentiality and be able to work without constant supervision. Ability to add, subtract, multiply and divide in all units of measure using whole numbers, common fractions and decimals preferred. Ability to compute rates, ratios, and/or percentage preferred. Ability to define problems, collect data, establish facts and draw valid conclusions. Physical Demands: While performing the duties of this job, the employee is regularly required to stand; walk; sit; handle or feel; reach with hands and arms; talk; hear; and smell. The employee is frequently required to stoop, kneel, crouch or crawl. Applicant must be able to move quickly to retrieve a running child if applicable. The employee is occasionally required to climb or to balance. The employee must frequently lift and/or move up to 25 pounds and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. Must be able to clearly see the entire classroom and bus if applicable. Must have a valid Ohio Driver’s License and carry up-to-date vehicle insurance to be permitted to drive on agency premises or while conducting agency business. Must have ready access to a working vehicle. Notice: There is no guarantee of a job offer or job interview in completing our application form. Your application will be considered with others who have submitted applications and decisions about interviews will be based on this comparison. Our application must be completely filled out in order for it to be considered for employment. DO NOT use “see resume” as an answer. If the information provided on our application cannot be satisfactorily verified by employment reference checks your application could be considered as incomplete. Read a copy of the job description before filling out our application form. Due to the large number of applications we receive and the competitive nature of our employment process specific reasons for employment will not be released. In completing our application form you will be subject to the following checks: EMPLOYMENT REFERENCE CHECK FROM FORMER EMPLOYERS CRIMINAL RECORD CHECK DRUG SCREEN Ohio Heartland Community Action Commission has in effect a clean air/smoking/tobacco use policy which prohibits smoking or use of other tobacco products in all offices and on or in any agency owned or occupied properties or vehicles. This policy applies to ALL Ohio Heartland Community Action Commission staff, regardless of program. I have read the above statements hereby acknowledge and understand that Ohio Heartland Community Action Commission may conduct background checks with the Bureau of Criminal Investigation and that such checks may involve fingerprinting.