Apply for a Career with Grace Lutheran Communities

Applicant Information

Position Applying for:

Full Name:

Address:

Telephone:

E-mail:

Best time to call you at home:

:

May we contact you at work?

Yes No

Work Phone:

Referral Source

Relationship:

Are you 18 years of age or older?

Yes No

Date Available:

Hourly wage expected:

Type of employment:

Shift preference:

Days available to work:

Su M Tu W Th F Sa

Do you have any commitments or responsibilities that might prevent you from meeting attendance requirements or that might require lengthy absence from work?

Name and relationship of relatives employed at Grace Lutheran Foundation:

Other names under which you have been employed:

Answering “yes” to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, and position applied for will be taken into account.
Have you ever pled ”guilty”, “no contest” to, or been convicted of a crime?	Yes No	If yes, please provide dates and details:
Have you ever been employed by Grace Lutheran Foundation or American Lutheran Homes?	Yes No	If yes, give dates and locations:
Have you ever submitted an employment application with Grace Lutheran Foundation?	Yes No	If yes, when and position applied for:
Are you a citizen of the United States?	Yes No	If no, are you authorized to work in the US?	Yes No
Are you presently employed?	Yes No	May we contact your present employer?	Yes No

Education


Elementary		Address:
	Course of Study:		Did you graduate?	Yes No	Degree:


High School:		Address:
	Course of Study:		Did you graduate?	Yes No	Degree:


College:		Address:
	Course of Study:		Did you graduate?	Yes No	Degree:


Other:		Address:
	Course of Study:		Did you graduate?	Yes No	Degree:

List any special skills or qualifications:

References

Please list three references. Do Not list former employers or relatives.


Full Name:		Relationship:
Occupation:		Phone:
Address:		Email:


Full Name:		Relationship:
Occupation:		Phone:
Address:		Email:


Full Name:		Relationship:
Occupation:		Phone:
Address:		Email:

Previous Employment


Company:			Supervisor:
Address:			Telephone:
Job Title:	Starting Salary:			Ending Salary:
		Reason for Leaving:
Description of Duties:


Company:			Supervisor:
Address:			Telephone:
Job Title:	Starting Salary:			Ending Salary:
		Reason for Leaving:
Description of Duties:


Company:			Supervisor:
Address:			Telephone:
Job Title:	Starting Salary:			Ending Salary:
		Reason for Leaving:
Description of Duties:


Company:			Supervisor:
Address:			Telephone:
Job Title:	Starting Salary:			Ending Salary:
		Reason for Leaving:
Description of Duties:

ADDITIONAL DETAILS: Please list any additional employment not shown above, or any information you believe would be helpful to us. (You may exclude all information indicative of age, sex, race, religion, color, national origin, marital status or disability).

Application Say Grace!