Application for Employment

Please Fill out the Short Form below, so we know you’re interested.

After filling out the short form, Please download the full Employment Application, fill it out, and then Email it back to us, or print it out and bring it in.

Any Questions Please Call and ask to speak with the Business office.

Please download and complete this form.

The completed application can be emailed to lbartos@midneluth.com, mailed to PO Box 459 or delivered to 109 N 2nd Street, Newman Grove, NE 68758.

Now Hiring for RN, LPN, MA, or CNA, Dietary, and Housekeeping/Laundry

Mid-Nebraska Lutheran Home and Newman House is an Equal Opportunity Employer.

Mid-Nebraska Lutheran Home Employment Application

Name *

First

Middle

Last

Position Applying For:

Phone *

Email *

Address: Current Address (EX. 123 Any Street, Any Town, State 12345 *

Previous Addresses Last 10 Years

Have you Worked for us before?

• Yes
• No

If yes, what dates, and Position?

Do you have Friends, Relatives or Acquaintance's that work for the facility?

US Citizen

• Yes
• No
• Registered

Crimes, Convictions, Violations: (Do not list Sealed,or Expunged Convictions)

Education: (Please type in School Name, Years Attended, and Course degree achieved.

Additional Education or training information:

Previous Work History (List Employer, duration of stay, and Contact Info.)

Reference #1 Name; Phone; Email

Reference #2 Name; Phone; Email

Reference #3 Name; Phone; Email

Submit