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Online Application

Apply Online - anywhere at anytime!

    I would like to apply for the following position:
    CNACMARNLPNHealthcare AideDietary AideCookHousekeeping AideOther

    If position was not listed and you chose other, what position are you applying for?

    How did you hear about this position?
    Current EmployeeFriendRelativeWalk-InIndeedLinkedInPerry ChiefChiefland ShopperFacebookRadioPerry NewsChat SheetFront SignInternet SearchOther


    PERSONAL INFORMATION

    First Name
    Middle Name
    Last Name

    Street Address
    City
    State
    Zip Code

    Phone
    Email

    Best method to contact you?PhoneEmailBoth

    Best time of day to reach you?MorningAfternoonEveningAnytime


    If employed, and you are under 18, can you furnish a work permit?YesNoNot Applicable


    Have you filed an application here before?YesNo
    If yes, what date did you file the application?


    Have you been employed here before?YesNo
    If yes, when was your last date of employment?


    Are you employed now?YesNo
    If yes, may we contact your present employer?YesNo


    Are you prevented from lawfully becoming employed in this country?YesNo

    If hired, you will be required to submit documents sufficient to establish employment authorization and identity in compliance with the Immigration Reform and Control Act of 1986. While you need not provide this proof of citizenship or immigration status at the time you are interviewed, please be prepared to assure us that you can do so immediately upon being hired.


    What is the earliest date you are available for work?
    Are you available to work:Full TimePart TimeTemporary


    What days of the week are you able to work?SunMonTueWedThuFriSat


    Do you have a record of founded child or dependent adult abuse in Iowa or any other state?YesNo

    Have you been convicted of a felony crime in this state or another state within the last 7 years?YesNo

    If yes, please explain?

    Conviction will not necessarily disqualify applicant from employment.


    REFERENCES

    Please provide name, address and telephone number of three references who are not related to you and are not previous employers:

    Reference #1 First/Last Name
    Reference #1 Mailing Address
    Reference #1 Telephone

    Reference #2 First/Last Name
    Reference #2 Mailing Address
    Reference #2 Telephone

    Reference #3 First/Last Name
    Reference #3 Mailing Address
    Reference #3 Telephone


    EDUCATION

    Elementary School Name
    Highest Elementary Grade Completed

    High School Name
    Highest High School Grade Completed
    High School Diploma?YesNo

    College Name
    Number of Yrs of College Complete
    College Field of Study
    College Degree Earned

    Graduate School Name
    Number of Yrs of Graduate School Complete
    Graduate Field of Study
    Graduate Degree Earned


    CERTIFICATIONS

    Do you hold any certifications, specialized training, or skills?YesNo

    If yes, please detail the certification, training or skills including the name of certification, location of training, length of coursework, and any other important information:


    EMPLOYMENT HISTORY


    Please start with your most recent job.
    EMPLOYER #1

    Employer
    Employer Address
    Employer Phone

    Position Held
    Supervisor Name
    Hourly Pay or Salary

    Starting Employment Date
    Ending Employment Date

    Type of Work Performed
    Reason for Leaving


    EMPLOYER #2

    Employer
    Employer Address
    Employer Phone

    Position Held
    Supervisor Name
    Hourly Pay or Salary

    Starting Employment Date
    Ending Employment Date

    Type of Work Performed
    Reason for Leaving


    EMPLOYER #3

    Employer
    Employer Address
    Employer Phone

    Position Held
    Supervisor Name
    Hourly Pay or Salary

    Starting Employment Date
    Ending Employment Date

    Type of Work Performed
    Reason for Leaving


    What most excites you about the possibility of working at Perry Lutheran Homes?

    Signature of Applicant
    Date of Application

    Signature of Guardian (required if applicant is under 18 years of age)
    Date of Guardian Signature (if applicant is under 18 years of age)

    These answers are true and complete to the best of my knowledge. Perry Lutheran Homes may investigate all statement contained in this application, and I understand that any false or misleading information provided may result in my immediate discharge. I understand that this application is not a contract of employment any employment relationship between myself and Perry Lutheran Homes is considered at-will.

    I also understand that any offer of employment will remain contingent until successful completion of all hiring requirements as outlined by Perry Lutheran Homes. This will include, but not limited to, a criminal and abuse background check, physical examination, pre-employment TB test, and a test for drugs and alcohol. This includes an annual flu vaccination.

    I certify that all matters contained in this application are true, and that any misleading or false statements would render this application void and would be sufficient cause for immediate dismissal in the event of employment. I understand that this is an application for employment and that no employment contract is being offered.

    I hereby authorize Perry Lutheran Homes to investigate all matters contained in this application and to contact prior employers to obtain any and all information related to my past performance. I agree, if employed, to abide by all Perry Lutheran Homes rules and regulations. I understand that such employment is for an indefinite period of time and that the company can change wages, benefits and conditions of employment at any time.

    I understand that I am required to immediately notify Perry Lutheran Homes if any action is proposed to exclude me from participation in any federal or state Medicare, Medicaid or third-party payor program.

    I have read and understand the above. By clicking submit, I agree that my electronic signature constitutes my written signature, and to have all the above information transmitted electronically to Perry Lutheran Homes.

    Form not submitting? No worries, it likely means information is missing. Scroll back up and fill in any fields that are outlined in red. Then, re-submit.

    Please note: Perry Lutheran Homes campuses are tobacco free campuses and smoking or the use of tobacco products is not allowed. Employees shall not smoke cigarettes, electronic cigarettes or similar devices during their work shifts at any time or location including meal breaks or other breaks.

    Perry Lutheran Homes (Lutheran Home for the Aged Association - West) is an Equal Opportunity Employer.