Employment Application

Orange Grove Center thanks you for your interest in applying for a job with our company.

Please accept this as the official notification of the documents that you are REQUIRED to provide to the Human Resources Department BEFORE being considered for employment.

  1. Proof of completion of high school, a GED. College degree is required for some positions
  2. Documents that establish identity and employment eligibility include copy of driver’s license or State-issued ID and Social Security Card.
  3. Three-year Motor Vehicle Record (MVR) required for positions that involve driving a company vehicle.

To expedite the employment process, it is recommended that you secure these documents and have them available should you be called for an interview.

The following convictions may result in the agency rescinding any job offer made:

(1) Any felony or;
(2) A misdemeanor involving physical harm to a person including but not limited to neglect or abuse or a misdemeanor involving financial harm/exploitation to a person including but not limited to theft, misappropriation of funds, fraud or breach of fiduciary duty; or
(3) a misdemeanor involving illicit drugs, drug/alcohol misuse or sexual misbehavior (e.g. indecent exposure, voyeurism) within ten years prior to employment with OGC; unless the misdemeanor conviction is a first and only occurrence of a DUI (DUI 1), public intoxication, or simple possession of marijuana, then it shall not have occurred during a period of less than one (1) year prior to employment

Any job offers will be contingent upon satisfactory completion of the following.

  • Reference and Background checks
  • Finger Printing – (See the attached Request for an Exemption if you have a felony or misdemeanor conviction)
  • TB Testing
  • Drug Screening
  • Medical Screening (physical)

Any and all employment offers would be contingent upon successful completion of the entire OGC employment process. Assuming you are offered employment, paid training must be successfully completed prior to starting your job.

The entire process from application submittal to job offer may take from 11 to 30 days depending upon your level of cooperation.

If the background check results received are deemed unsatisfactory, you will be notified in writing. Once you have received written notification, you have the right to appeal. The appeal process is only available for candidates who were denied employment due to an unsatisfactory criminal background report.


Applicants will be provided with information regarding DIDD prohibitions on hiring and employing individuals with a felony or misdemeanor conviction, and informed that they may request an exemption from the DIDD prohibition via the following process:

  • The applicant must submit the request for an exemption in writing to the OGC CEO, Tera Roberts, [email protected] along with his or her application, or in the case of an employee, within five (5) business days of receiving notice of the background check results from OGC.
  • The OGC Executive Director will confer with a committee comprised of the Human Resources Director, a member of the OGC Board of Directors, and others as assigned by the Executive Director and/or Board. The Committee at its discretion may ask for additional information from the applicant or employee.
  • If the Committee denies the exemption request, the applicant shall not be hired or the employee shall be terminated.
  • If the Committee approves the exemption request, the request will be submitted to The DIDD through the DIDD exemption process. The DIDD has final approval of all exemptions.

Reimbursement for Pre-Employment Testing

Orange Grove Center requires all applicants to whom a job offer is made to submit to the following pre-employment tests: finger printing, TB skin testing, drug screening, and medical screening (physical).

Each of these tests are done at no cost to the applicant. Orange Grove Centers incurs the full cost. Prices are subject to change


TB Testing
Drug Screening (Non-DOT)
Medical Screening (physical)


TB Testing
Drug Screening (Non-DOT)
Medical Screening (physical)

All employees whose employment is terminated during their first six (6) months with the company, and all full-time employees who elect to transfer to part-time status during their first six (6) months with the company, will be responsible for the cost of the pre-employment tests previously incurred by OGC on their behalf. The applicable amount will be deducted from their wages of the payroll check immediately following when notice is received in the HR/Payroll Departments.

Employment Application

The Orange Grove Center
615 Derby Street * Chattanooga, Tennessee 37404

This application will remain active for 3 months from the date you apply

Current Open Position for Which You Are Applying:

Res 286 Pos #462 Req #11444 Direct Support Professional 05


High school diploma or GED

Social Security Card or original Certificate Of Birth

Valid Drivers License

Acceptable 3-year motor vehicle report

F endorsement on Drivers License, 30 days past job offer

Direct Support Professionals (DSPs) may work in one of three (3)residential settings: ICF/IID, Residential Habilitation, or Supportive Living. Will provide direct care for 1 to 8 individuals. Pay is based upon the residential setting.

SPECIAL QUALIFICATIONS: A high school diploma or GED is required in all departments. Driver's License, Motor Vehicle Report(MVR), and class "F" endorsement are required in all residential settings. Supported Living needs Med Certification as well.

RESPONSIBILITIES: Will support individuals in all daily activities. Such as; preparing meals and eating, all aspects of personal hygiene, selecting clothing and dressing, transport to and from the day program as well as doctors appointments, etc. Will attend community outings with the individuals. Will meet all personal outcomes and complete all paperwork and daily notes. Must assist with laundry and making sure that the individuals environment is kept neat and clean.Will keep all training current. Must communicate respectfully toward supervisor and all staff, family members and individuals. Any other duties as assigned.

$10.00 Hour


Job Related Skills

Are you legally eligible for employment in the United States?

Do you have a valid driver’s license?

Have you had any moving traffic violations?

Have you ever been licensed or practiced professionally under a different name?

Have you ever had a nursing license, or other professional license, in any jurisdiction limited, suspended, revoked or relinquished?

Have you ever been sanctioned for misconduct?

Have you ever had any malpractice claims, suits, settlements or arbitration proceedings involving your professional practice?


Education History

High School

Check Last Year Attended


Check Last Year Attended

College #2 / Graduate (if applicable)

Check Last Year Attended

Employment History

YOU MUST COMPLETE THE ENTIRE SECTION, EVEN IF YOU SUBMIT A RESUME. We must make every effort to contact previous employers, for whom you have worked 6 months or more. List ALL employers for the last 10 years.

Current or Most Recent






Personal References

This section MUST be completed. DO NOT include relatives or previous employers. Include only individuals familiar with your work ability and character. Each MUST have known you for at least five (5) years.

Have you been convicted of or served time for a felony? List below.

Have you been convicted of a misdemeanor involving physical harm to a person including but not limited to neglect or abuse or a misdemeanor involving financial harm/exploitation to a person including but not limited to theft, misappropriation of funds, fraud or breach or fiduciary duty?

Have you been convicted of a misdemeanor involving illicit drugs, drug/alcohol misuse or sexual misbehavior (e.g. indecent exposure, voyeurism) within the last ten years?

Have you been convicted of child abuse?

Has a child in your custody or control ever been declared dependent or neglected?

If yes to any of the above, please list below.

(In accordance with Orange Grove Center, Inc., policy a conviction will not necessarily disqualify you from the job for which you are applying. A conviction will be judged on its own merits with respect to time, circumstances, and seriousness.)

Emergency Contact

Applicant Waiver

Name of Agency & Region: The Orange Grove Center


I am applying for employment / licensing / education / adoption with the following agency/entity: The Orange Grove Center, Inc.

By signing this waiver, I am agreeing to the release of any and all of my criminal history, including any juvenile history that may be in the GBI, TBI and FBI criminal databases, to the aforementioned entity/agency.


I hereby certify that I have read this application and the answers given by me to the questions and statements are complete and true. I understand that any false information, omissions, or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize The Orange Grove Center, Inc., and /or its agents, including consumer-reporting bureaus, to verify any of this information. I authorize all former employers, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said employers, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information.

I, the undersigned applicant, certify and affirm that, to the best of my knowledge and belief; I have or I have not had a case of abuse, neglect, mistreatment or exploitation substantiated against me. As a condition of submitting this application and in order to verify this affirmation, I further release and authorize The Orange Grove Center, Inc., the Tennessee Department of Intellectual and Developmental Disabilities (DIDD) and the Bureau of TennCare to have full and complete access to any and all current or prior personnel or investigative records, from any party, person, business, entity or agency, whether governmental or non-governmental, as pertains to any allegations against me of abuse, neglect, mistreatment or exploitation and to consider this information as may be deemed appropriate. This authorization extends to providing any applicable information in personnel or investigative reports concerning my employment with this employer to my future employers who may be Providers of DIDD services.

Pre-Employment Drug Testing Consent and Release Form

I hereby consent to submit to urinalysis or other tests as shall be determined by The Orange Grove Center, Inc., in the selection process of applicants for employment, for the purpose of determining the drug content thereof.

I agree that a provider selected by The Orange Grove Center, Inc., may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the company for analysis.

I further agree to and hereby authorize the release of the results of said tests to The Orange Grove Center, Inc.

I further agree to hold harmless The Orange Grove Center, Inc., and its agents (including the above named physician or clinic) from any liability arising in whole or in part out of the collection of specimens, testing, and use of the information from said testing in connection with The Orange Grove Center's consideration of my employment application.

I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.

Equal Employment Opportunity Affirmative Action

Applicant Voluntary Self-Identification Form

Our company is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, color, religion, gender identity, sexual orientation, national origin, age, disability, or any other basis prohibited by federal, state, or local law. No question on this form is intended to secure information to be used for such discrimination.

We are subject to certain governmental record-keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the Company invites applicants to voluntarily self-identify their gender, race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable law, executive orders and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. The data will not identify specific individuals.

Active U. S. Military?

Military Veteran?

Disabled Veteran?

Please indicate your gender and choose from one of the seven racial/ethnic categories below.

- A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
- A person having origins in any of the original peoples of Europe, the Middle East or North Africa.

- A person having origins in any of the black racial groups of Africa.

- A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.

- A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent, e.g., Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

- A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

- A person who identifies with more than one of the above races, excluding those who identify themselves as Hispanic or Latino.