Employment Application : Who We Are : Mental Health Association of Nebraska

Online Employment Application

First Name

Last Name

Address (Line 1)

Address (Line 2)

City

State

Zip

How long at current address

Phone

Position(s) Applying For

Check all that you are interested

REAL outreach worker
Omaha Peer Support
Peer Specialist

How many hours do you want to work a week?

Date Available to Start

Employment desired

Full-Time Only
Part-Time Only

Mark all options that you would be available for:

Check all that apply

Weekends
Saturday
Sunday
Overnight
Holiday
Weekdays only

Mark all shifts that you are interested in?

Check all that apply

6a-2p
10a-6p
2p-10p
6p-2a
10p-6a
9a-5p

Education

High School/Location/Years Completed/Graduate/GED

High School Information/Date Completed

College/Location/Years Completed/Degree

College/Location/Years Completed/Degree/Date

Employment History Last 5 Years

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Name, Address, Phone, Dates, Position, Supervisor, and Job Responsibilities

Do you have driver's license?

Do you have a reliable means of transportation for the position you are applying for?

Have you had any auto accidents and/or moving violations in the past 3 years?

Have you completed Intentional Peer Support training?

Professional References

References

Use this space to summarize any additional information necessary to describe your full qualifications for the position for which you are applying.

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.