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Employment Application

Online Employment Application
Position(s) Applying For
Check all that you are interested
Employment desired
Mark all shifts that you are interested in?
Check all that apply
High School Information/Date Completed
College/Location/Years Completed/Degree/Date
Have you completed Intentional Peer Support training?
Have you ever been convicted of a crime?
If Yes, Please document specifics
Do you have driver's license?
Have you had any auto accidents and/or moving violations in the past 3 years?
Professional References
Employment History Last 5 Years
By agreeing here, I authorize the Mental Health Association of Nebraska to complete background checks, also I indicate my awareness that false statements or failures to disclose certain information may be sufficient to disqualify me from employment, or, if employed, may result in dismissal.
I authorize investigation of all statements contained herein.
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