Cornerstone Supported Living, LLC.
519 S. Otterbein Ave., Suite 7 • Westerville, Ohio 43081 • (614) 882-4499 • Fax (614) 882-4491

Cornerstone Supported Living, LLC. is an Equal Opportunity Employer. Applicants for all job openings are welcome and will be considered without regard to race, color, religion, national origin, sex, age, sexual orientation, physical or mental disability, or any other basis protected by state, federal or local law. It is the intent of Cornerstone Supported Living, LLC. to comply with all applicable federal, state and local legislation concerning equal opportunity in employment.

Please complete this Application as thoroughly as possible to help us learn about your experience, abilities, and interests.

Personal Information
Will be requested after submission
Employment Desired
US Military Service Data

Education and Training

High School

Community College/Trade School



Additional education, vocational and/or professional information such as special areas of research or study, seminars, etc. Familiarity with a foreign language may be included, if it applies to the job desired. Professional memberships, certificates or licenses held. (Exclude those indicating race, religion, sex, sexual orientation, national origin, age, physical or mental disability or labor organization affiliations.) Supplement this information by written attachment if applicable.

Employment Data

Please List in order of most recent employment first! (10 years of history is sufficient).

Pre-Employment Certification

I understand that this application is only valid for the position applied for at present and that Cornerstone Supported Living is not obligated to retain or consider this application for future openings.

I authorize investigation of all statements in this application. I understand that falsification, misrepresentation or omission of facts called for will result in immediate termination from employment or removal of my application from consideration. I authorize Cornerstone Supported Living to secure information about my experience with former employers, education institutions and agencies, and for those parties to provide information concerning my experience, releasing all parties from any liability arising therefrom.

If I am employed by Cornerstone Supported Living, I understand my employment can be terminated, with or without cause and with or without notice, at any time at the option of Cornerstone Supported Living or myself. I understand that, other than the Directors of Cornerstone Supported Living, no manager, supervisor or representative of Cornerstone Supported Living has authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. Only the Directors of Cornerstone Supported Living have the authority to make any agreement contrary to the foregoing and then only in writing. I further expressly agree that, with respect to the at-will employment relationship, this constitutes the full, complete and final expression of the parties’ intent concerning the nature of any employment relationship between myself and Cornerstone Supported Living.

My signature below certifies that I have read and understand the foregoing and to the best of my knowledge and belief, the information on this form is true and correct. My signature below also certifies that I agree to be bound by the terms and conditions stated in this application, including the arbitration provision set forth above. This application contains all understandings and agreements between my and Cornerstone Supported Living concerning the nature of my employment, if any, by Cornerstone Supported Living and supersedes all prior and/or contemporaneous practices, oral or written agreements, understandings, statements, representations and promises, express or implied, between me and Cornerstone Supported Living. I understand and agree, except as noted above, no person who is either an agent or employee of Cornerstone Supported Living may modify , delete, vary or contradict, whether orally or in writing, the terms and conditions of employment set forth herein.