Employee Application Form

Bethany Lutheran Home for the Aged, Inc. is an equal opportunity provider and employer.

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Applicants Statement: ( to be signed at interview)

Bethany Lutheran Home is committed to providing a drug and alcohol free environment. The use, possession, transfer or sale of illegal drugs or alcohol is not permitted on Bethany's property, either on or off duty. By my signature, I hereby give my consent to provide a urine sample or take a breath test to test for drugs and/ or alcohol, if requested by facility.

 I further understand, that any offer of, or continued employment is contingent upon:

  • Successful completion of a health assessment and drug test.
  • Satisfactory completion of reference checks with past employers and/ or personal references; and
  • Verification of current status with applicable licensing and certification authorities, when necessary.
  • Successful completion of criminal background check.  


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Applicant's Signature                                                                                                  Date

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