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Employment Application

Online Employment Application
Position(s) Applying For
Check all that you are interested
Employment desired
Mark all options that you would be available for:
Check all that apply
Mark all shifts that you are interested in?
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Education
High School Information/Date Completed
College/Location/Years Completed/Degree/Date
Employment History Last 5 Years
Do you have driver's license?
Have you had any auto accidents and/or moving violations in the past 3 years?
Have you completed Intentional Peer Support training?
Have you ever been convicted of a crime?
If Yes, Please document specifics
Professional References
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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