Online Application

I would like to apply for the following position: *

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

How did you hear about this position? *

If you chose "other" for how you heard about us, please tell us how you heard about this position. *

If you found out about this position through a current employee, please enter their name. *

Personal Information

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Best method(s) to contact you? *

Email
Phone Call
Text

Best time of day to reach you? *

Morning
Afternoon
Evening
Anytime

Employment Basics

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

Yes
No
Not Applicable

Have you filed an application here before? *

Yes
No

Have you been employed here before? *

Yes
No

Are you employed now? *

Yes
No

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

Yes
No

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.

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

Yes
No

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

Yes
No

Conviction will not necessarily disqualify applicant from employment.

If convicted of a felony crime in the last 7 years, please explain. *

Are you available to work: *

Full Time
Part Time
Temporary

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

What is the earliest date you are available for work? *

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 Telephone *

Reference #1 Email

Reference #2 First/Last Name *

Reference #2 Telephone *

Reference #2 Email

Reference #3 First/Last Name *

Reference #3 Telephone *

Reference #3 Email

Education

High School Name *

Highest High School Grade Completed *

Do you have a high school diploma or GED? *

Yes
No

College Name (if applicable)

Number of Years of College

College Major

College Degree Earned

Grad School Name (if applicable)

Number of Years of Grad School

Grad School Major

Grad Degree Earned

Certifications

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

Yes
No

If yes, please list your certification(s), specializations, etc. below: *

Employment History

Please start with your most recent job.

#1 - Most Recent Employer Name

Position Held

Employer Address

Supervisor Name

Employer Phone

Hourly Pay or Salary

Starting Employment Date

Type of Work Performed

Ending Employment Date

Reason for Leaving

#2 - Second Most Recent Employer Name

Position Held

Employer Address

Supervisor Name

Employer Phone

Hourly Pay or Salary

Starting Employment Date

Type of Work Performed

Ending Employment Date

Reason for Leaving

#3 - Third Most Recent Employer Name

Position Held

Employer Address

Supervisor Name

Employer Phone

Hourly Pay or Salary

Starting Employment Date

Type of Work Performed

Ending Employment Date

Reason for Leaving

Sign & Acknowledge

What most excites you about the possibility of joining the Perry Lutheran Homes Family? *

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)

Upload Resume (If Applicable)

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 checking the box and 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.

I acknowledge all of the above. *

Yes

Apply Online - anywhere at anytime!

Personal Information

Employment Basics

References

Education

Certifications

Employment History

Sign & Acknowledge

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