Mother Hull Home Application for Employment

 
Mother Hull Home 125 East 23rd St Kearney, NE 68847 (308) 234-2447 On-Line Application for Employment
 
 
1 Name
 
2 Phone
 
3 Present
Address
 
4 Permanent Address
 
5 Email Address
 
6 Position
 
7 Availability
Day 6 to 2
Evening 2 to 10
Night 10 to 6
Weekends
Holidays
On Call
 
8 Professional License or Certification
Type
Organization
or State Issued
 
9 High School Diploma
 
10 College Degree
 
11 Employment History
Company
Dates Employed
Position
Supervisor Name
May we contact
Phone
 
12 Employment History
Company
Dates Employed
Position
Supervisor Name
May we contact
Phone
 
13 Reference
Name
Relationship
Phone
 
14 Reference
Name
Relationship
Phone
         
       

Mother Hull Home does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, Vietnam era veteran status, or on the basis of age or physical or mental disability unrelated to ability to perform the work required.  No question on the application is intended to secure information to be used for such discrimination.

I understand that my employment is at will, and that either party is free to terminate the employment relationship at any time without cause.  I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.

I voluntarily give Mother Hull Home the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. 

If employed, I understand that I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.