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Employment Application

Join Our Team!
Are you at least 18 years of age?
Are you at least 16 years of age?
Have you ever been employed at Bethany Home before?
Are you employed now?
May we contact your present employer?
Work availability:
Are you capable of performing the job for which you are applying?
What days of the week are you available to work? (Select all that apply.)
What hours are you available to work? (Select all that apply.)
Do you have a record of founded child or dependent adult abuse or have you ever been convicted of a crime other than a simple misdemeanor offense relating to motor vehicles and laws of the road under Chapter 321 or equivalent provisions, in this state or any other state?
Are there currently any criminal charges involving you, or are you under investigation for child or dependent adult abuse?
Did you receive a high school diploma or GED?
How many years of College/University did you complete?

Employment History

An Equal Opportunity Employer

This facility is an equal opportunity employer. Employment decisions are made without regard to age, race, creed color, sex, sexual orientation, gender identity, national origin, religion, disability, status as a disable Vietnam era veteran, or other category as specified by law.

Applicant's  Statement


I certify that the answers giving in this Employment Application are true and complete to the best of my knowledge. The facility may investigate all statements made in this Application. The facility is required by law to check for any criminal or abuse record. I understand that any false or misleading information provided can result in a decision not to hire, immediate discharge if hired, and civil or criminal penalties in appropriate cases. In signing this Application, I state that I have reviewed the Job Description(s) for the job(s) for which I have applied. I understand that the failure to fulfill any aspect of the job may result in termination. I also understand that I may be required to take a physical examination conducted by a physician of the employer's choosing after I am given a qualified offer of employment and that a health screening for diseases, such as tuberculosis (TB), is required. I understand that if hired, I am required to abide by all rules and regulations of the facility.

By typing in your legal name, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.

Thank you! We’ll be in touch.

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