Apply to Work at Bethany Home

Fill out the form below to apply to work at Bethany. You can also download a PDF version of our employment application to fill out and mail to 1226 Berlin Street Waupaca, WI 54981.

Step 1 of 6

General Application for Employment at Bethany Home, Inc.
Bethany Home is an equal employment opportunity employer dedicated to a policy of non-discrimination in employment based upon an individual’s race, color, creed, religion, age, sex, national origin, ancestry, marital status, sexual orientation or the presence of any non-job-related medical condition or disability. In reading and answering the following questions, please keep in mind that none of the questions are intended to imply any limitations, illegal preferences, or discrimination based upon any non-job-related information. This application will be given consideration, but its receipt does not imply that the applicant will be interviewed or employed. Please contact the Director of Human Resources if you need an accommodation to participate in the application process at 715-942-1500.
Application Information
Position Applying For*
Date Available to Start Work*
MM slash DD slash YYYY
Referral Source*
- Walk-In
- Employee
- Advertisement
- Comany's Website
- Other Internet
Personal Information
Name*
FirstLast
Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Daytime Phone Number*
Evening Phone Number*
Email*
Attach Resume
Drop files here or
Accepted file types: pdf, Max. file size: 3 MB, Max. files: 2.
Note: Files must be under 3MB and be PDFs. You can only upload 2 files max.

Employment History
List Present or Most Recent Employer first – Please complete even if a resume is attached.
Company 1
Company Name
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
FirstLast
Supervisor Phone Number
Reason for Leaving
Job Title and Duties
Final Salary
Enter amount and if it was per hour or year.
May we contact?
- Yes
- No
Company 2
Company Name
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
FirstLast
Supervisor Phone Number
Reason for Leaving
Job Title and Duties
Final Salary
Enter amount and if it was per hour or year.
May we contact?
- Yes
- No
Company 3
Company Name
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
FirstLast
Supervisor Phone Number
Reason for Leaving
Job Title and Duties
Final Salary
Enter amount and if it was per hour or year.
May we contact?
- Yes
- No

Please account for any time you were not employed after leaving school in the past ten years (You need not list any unemployment periods of one month or less)

Time Period(s)	Reason(s) for Unemployment

Employment History Continued

References

Name	Address	City, State, ZIP	Phone Number	Occupation

List three BUSINESS RELATED INDIVIDUALS that are NOT former employers

Other Job Related Experience
Some people gain job-related experience in positions other than as an employee. For instance, an accountant may gain experience as a treasurer of a civic or school organization, or a manager may gain experience while working on civic projects or in school organizations, or in PTA activities.
Please list and describe any paid or unpaid activities, honors, experience, or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application.
You may omit any activities, honors memberships or other items that ten to identify your race, sex, national origin, age, disability or other personal traits that you prefer not to disclose.
Please add any additional information (except that which identifies your race, sex, age, religion, national origin, disability or other non-job-related personal information) that you think may be relevant to a decision to hire you.
IMPORTANT
Please read carefully and initial each paragraph before electronically signing (entering your full name).
Initials*
By my signature and initials, I promise that the information provided in this employment application (and accompanying resume if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment by Bethany Home if discovered at a later date. I agree to immediately notify Bethany Home if I should be convicted of a felony, or any crime involving dishonesty or a breach of trust while my job application is pending, or during my period of employment, if hired.
Initials*
I authorize any person, school, current employer (except as previously noted), past employer(s), government or investigative agencies, and other organizations that may be named in this application form (and accompanying resume, if any) to provide Bethany Home with relevant information and opinion that may be useful to Bethany Home in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.
Initials*
I understand that, if hired, I may not hold other employment, nor engage in consulting, sales, investments or other activities that may create a conflict of interest with Bethany Home.
Initials*
I understand that if employed and my employment is terminated by Bethany Home for dishonesty, breach of trust, or any criminal acts, the authorities may be notified and I may be criminally prosecuted.
Initials*
I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time.
Applicant Signature*
Date*
MM slash DD slash YYYY

Employment Reference Authorization
Date*
MM slash DD slash YYYY
Applicant Name*
FirstLast
Applicant Address*
Use Address from General Information
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Other names under which I have worked*
To Whom It May Concern:
I have applied at Bethany Home, Inc. for a position. I hereby authorize you to furnish Bethany Home, Inc. with all the information requested, and any other information you have concerning me. I hereby release you, your organization and Bethany Home, Inc. from all liability for any damage whatsoever arising there from.
Thank you,
Applicant Signature*
Name
This field is for validation purposes and should be left unchanged.

Apply to Work at Bethany Home

Step 1 of 6

General Application for Employment at Bethany Home, Inc.

Application Information

Personal Information

General Information

Education Information

High School Information

Technical, Vocational, Business, or Military Training Information

College or University Information

Graduate School Information

Professional Seminars Information

Employment History

Company 1

Company 2

Company 3

Employment History Continued

Other Job Related Experience

IMPORTANT

Employment Reference Authorization

Name of Seminar	Location of Seminar