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-InIndeedPerry 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

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, and a test for drugs and alcohol.

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 contract 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.

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