2825 Bloomfield Road • Cape Girardeau, MO 63703
Phone: 573-335-0158 • Fax: 573-986-6212

This application is not an employment contract but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status provided under state and federal law.

Employment History

Provide the following information of your past three (3) employers, assignments, or volunteer activities, starting with most recent.

Skills and Qualifications

Educational Background

Personal References (Excluding former employers and relatives)

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with The Lutheran Home is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service regardless of when or how discovered I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview.

I understand that consideration for employment is conditional upon the results of my reference checks. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I agree, if I am offered and accept a position to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change, wages, hours, and working conditions as deemed necessary. I also understand that, if hired, my employment will be at-will, meaning that either party can end the employment relationship any time and for any or no reason.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice and The Lutheran Home reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute and agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of The Lutheran Home is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by The Lutheran Home president.

I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986. I authorize that I am lawfully eligible to be employed in the United States.

The Lutheran Home requires all new employees undergo drug screening.


Date: 2019/05/21