1. Welcome

Dear Applicant: Thank you for your interest in a position with Flat Rock Homes.  We consider this questionnaire to be your first interview (a “written interview”) for this position. To receive further consideration, please be sure to answer every question carefully and fully. It is in your best interest to write full answers for each question—the more information we have, the better we can assess your fit for our organization and the position. Please avoid one word answers like “yes” or “no”—explain yourself—use it as an opportunity to shine. Thank you for your cooperation!

For more information about our company, click:  Flat Rock Homes

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is today's date?

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* 5. If the position were offered to you, how soon after agreeing upon an offer could you begin work?

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* 6. Which shifts are you available to work? Indicate choices.

  I prefer this shift In addition to my preferable shift, I can work this shift Any shift I can only work this shift I can never work this shift
1st shift (day shift)
2nd shift (afternoon shift)
3rd shift (night shift)

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* 7. Which days are you available to work? Note: Due to the 24/7 nature of the operations, we must staff on weekends and holidays.

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* 8. I am interested in full time, part time, temporary, or substitute (PRN).  Please choose which you are interested in.  You may choose more than one.

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* 9. You must be at least 18 years of age and have a high school diploma or equivalent.  Do you meet this requirement?

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* 10. You must have a valid Ohio driver's license with less than six points and no more than two moving violations.  Do you meet this requirement?

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* 11. You must provide proof of auto insurance and must have auto insurance coverage at all times during employment.  Can you meet this requirement?

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* 12. If hired you will have to pass a post-offer pre-employment physical and drug screen.  We are a drug free workplace and you will need to pass drug screening and remain drug free.  We drug test upon hire, randomly, reasonable suspicion, & post accident.  Will you meet this requirement to remain drug free during employment and pass the post offer physical?

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* 13. Have you ever been fired, dismissed, discharged or asked to resign from any position? If so, please explain:  

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* 14. Why did you leave your previous position, or if you are still working, why are you seeking new employment?

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* 15. If hired, you must pass a criminal background screening. Have you ever been convicted of a crime (felony or misdemeanor) other than minor traffic violations? If so, please explain.   If you have a conviction, please provide the conviction and the date of conviction.  Provide the revised code of conviction if possible.

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* 16. What is your educational level?  

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* 17. If you answered that you have a degree in the question above; please provide the field of your degree:

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* 18. Please explain your experiences in the following areas including the number of months/years of experience in that category.  Please leave blank any areas where you have no experience:

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* 19. Please complete the following information regarding your last place of employment:

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* 20. Please complete the following information regarding your second to last place of employment:

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* 21. Please complete the following information regarding your third to last place of employment:

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* 22. Please complete the following information regarding your fourth to last place of employment:

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* 23. What has been the most significant accomplishment of your career thus far and why?

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* 24. What are your career goals for the future and how would accepting this position fit into those goals?

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* 25. Flat Rock Homes is a faith-based, non-profit agency.  We, however, do not discriminate based on your religion or lack of religion.  Are you comfortable working for a faith based company?

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* 26. Why should we hire you?  Please list the qualities you possess that you feel are the reasons why you are a good fit for this position.

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* 27. Please list your phone number, your full address and an email address so that we may contact you.

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* 28. If you were referred by a current Flat Rock employee, what is the employee's first name and last name?  If you were not referred by a current employee; please answer question with "N/A".

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* 30. If you answered yes to the question above, what is the first and last name of the current Flat Rock employee(s) that you are related to or are in a relationship with?

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* 32. The mission of Flat Rock Homes is to provide outstanding services which transform lives of persons with intellectual and developmental disabilities, their families and persons with critical needs through a dedication to caring and excellence that demonstrates Christian values.  Are you comfortable working for a company with a faith based culture and a mission statement such as ours?

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* 37. Due to our being Medicaid funded; we are mandated under CSM to ensure that all employees are fully COVID-19 vaccinated. If you are vaccinated, you'd just need to show proof of your vaccination for our records.

If you are not:
a. You must have completed the first dose of the primary vaccine series or have applied for and/or been granted a lawful exemption before December 6, 2021 and provided proof that they’ve done so. This means either shot #1 of the Pfizer/Moderna vaccines or the single-dose Johnson & Johnson shot must be taken BEFORE December 6 (which means on or before December 5).
If you chose Johnson and Johnson, you are done as soon as you submit this proof to Human Resources.

If you chose one of the other shots that require a second dose, you must also comply with phase II of the CMS rule which is:

All staff must have completed the second dose of the primary vaccine series or have been granted a lawful exemption before January 5, 2022. They must provide proof that the series has been completed. This means shot #2 of the Pfizer/Moderna vaccines BEFORE January 5, 2022 (which means on or before January)

Will you comply with this? Please note that to answer no to this question means that you will automatically disqualify yourself from employment with our company.

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