Application for Employment

Please Scroll Down and Fill out the Short Form at the bottom of the page, so we know you’re interested.

Please fill out this Interest for Employment Application. A Member of our Business Office will reach out to you as soon as possible.

Any Questions Please Call and ask to speak with LuAnn Bartos in the Business office.

Now Hiring for Certified Dietary Manager, Med-Aides

Registered Nurse, and Licensed Professional Nurse

Mid-Nebraska Lutheran Home and Newman House is an Equal Opportunity Employer.

Please complete the form the best that you can. Printed Version Available upon request.

Name *

First

Middle

Last

Position Applying For:

Desired Salary/Wage

Social Security Number

Birthdate 00/00/0000

Phone *

Email *

Address: Current Address (EX. 123 Any Street, Any Town, State 12345) *

Previous Addresses Last 10 Years (Include Dates Resided at Location)

Drivers License or State ID

Have you Worked for us before?

If yes, what dates, and Position?

Do you have Friends, Relatives or Acquaintance's that work for the facility?

US Citizen

Yes
No
Registered

Crimes, Convictions, Violations: (Do not list Sealed,or Expunged Convictions)

Education: (Please type in School Name, Years Attended, and Course degree achieved.

Additional Education or training information:

Have you Ever served in the U.S. Armed Forces: Please Specify

How did you Find us? Friend, Advertisement, Word of Mouth, Etc. ?

Previous Work History (List Employer, duration of stay, and Contact Info.)

Previous Wages (Starting Wage, End Wage)

Reason for Leaving Current Job?

Education (Please include: School attended, Address, and Number of Years attended)

Highest Grade Completed, Degrees, Certificates, Additional Education

Reference #1 Name; Phone; Email

Reference #2 Name; Phone; Email

Reference #3 Name; Phone; Email

Computer Experience (Check all that Apply)

Microsoft Office
General Computer Skills
Point Click Care
Relias Training

Emergency Contact (Name, Address, Phone, Relationship)

Directions: Mid-Nebraska Lutheran Home and Newman House is an Equal Opportunity Employer. MNLH Does not have an English Language only rule. This application should be filled in completely. If a question does not pertain to you please write “N/A” in that space. The answers that you provide on your application will be carefully checked for truthfulness and accuracy. When you are finished filling out the application please review prior to submitting it. Our company is an equal opportunity employer whose policy is to select the most qualified candidates for a job, without regard to race, religion, color, sex, national origin, gender, age, or marital status, history of disability. Please advise us if you need any accommodations to assist you in the application process. Click here for EEOC Employment practices.

Mid-Nebraska Lutheran Home Employment Application