Application For Employment

1Employment Desired

2Personal

3Education

4Experience

5References

6Other Information / Skills

7Applicant Statement

8Voluntary Information

Facility you are applying at:
Position(s) applied for
Hidden
Main Email
Hidden
Voluntary Information Email
Application is for:
Shift(s) you can work:
Are you available for weekend work?
- Yes
- No
Date on which you can begin your duties:
If employed, do you have a reliable way to get to and from work?
- Yes
- No

Name of Employer
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
From
To
Starting Position
Last Position
Responsibilities
Reason(s) for leaving or desiring to leave
Name and Title of Immediate Supervisor
May we contact?
- Yes
- No
Name of Employer
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
From
To
Starting Position
Last Position
Responsibilities
Reason(s) for leaving or desiring to leave
Name and Title of Immediate Supervisor
May we contact?
- Yes
- No
Name of Employer
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
From
To
Starting Position
Last Position
Responsibilities
Reason(s) for leaving or desiring to leave
Name and Title of Immediate Supervisor
May we contact?
- Yes
- No
After leaving school, please account for any time (lasting greater than one month) you were not employed in the past ten (10) years. Please do not include any unemployment periods pertaining to pregnancy, child care or disability.
Time Period
Reason(s) for unemployment
Time Period
Reason(s) for unemployment
Time Period
Reason(s) for unemployment

Name of Reference*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Relationship to you*
Occupation*
Name of Reference*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Relationship to you*
Occupation*
Name of Reference*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Relationship to you*
Occupation*

Important - Read Before Submitting

The facts set forth in my application are true and complete. I understand that if employed, false statements or important omissions may result in the termination of my employment. I authorize an investigation of all statements and matters contained herein. I authorize all my previous employers or other persons having information concerning me or my record(s) to report such information to The Lutheran Home Association and I release such employers and persons from all claims or liabilities whatsoever on account of their responding to such inquiries or making such disclosures.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between The Lutheran Home Association and myself.

I understand and agree that if I am employed by The Lutheran Home Association, such employment relationship is of an "at will" nature. This means that either party can terminate the relationship at any time with or without cause and with or without notice for any lawful reason.

I agree, if requested, to submit to a medical examination at The Lutheran Home Association's expense, by medical personnel designated by The Lutheran Home Association prior to and as a condition of their final acceptance of me as an employee.

The Lutheran Home Association will not discriminate against or harass any employee or applicant for employment because of race, color, creed, religion, national origin, sex, disability, veteran status, age, marital status, genetic information, status with regard to public assistance or any other characteristic or trait protected by applicable law.

I understand that a criminal background study will be conducted and results of the study could preclude me from employment if substantially related to the job or if applicable law requires its consideration.

By submitting this application, I affirm that I have read and agree to all terms and conditions of the Applicant Statement.

Thank you for completing this application form and for your interest in employment with The Lutheran Home Association.
Please check the box below.*
- I affirm that I have read, fully understand, and accept all of the terms and conditions included in this online application.

Application For Employment

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