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Application For Employment

Tell us about yourself.

Please provide all information requested on our application form.

Virginia Lutheran Homes, Inc. is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability, veteran status or any other characteristic protected by applicable federal, state or local law.

Click here to download our mail-in application.

 
Page 1 of 3
Required *  
Personal Information
First Name: *
Last Name: *
Middle Name:
Address: *
Apt:
City: *
State: *
Country:
Zip: *
Daytime Phone: Evening Phone:
E-mail: *
   
Position Information
Position Applied for: Volunteer Opportunities
Facility or Location: Brandon Oaks Retirement Community-Roanoke VA
   
Acceptable
Rate of Pay:
Full or Part Time: Full Time
Part Time
Both
Shift Preferred:
Other Available Shifts:
   
Emergency Information
Emergency Contact:
Relationship:
Telephone:
   
Eligibility Information
Are you legally eligible for employment in the United States?
Yes
Are you 16 years of age or older?
Yes
If not, can you furnish a work permit?
Yes
What Date will you be available for work?
Pick a date
 
Referral Source
Please select the appropriate category and name the source.
*
Have you submitted an application here before? *
Yes
If yes, give date(s)
and position(s).
Have you ever been employed here before? *
Yes
No
If yes, give date(s):
Position held:
Do you currently have any relatives who work for Virginia Lutheran Homes? *
Yes
No
If yes, list name
and relationship.
   
Required *
Education
School (Include City & State) Years Completed Degree Major/Minor
1.)    
2.)
3.)
4.)
   
Certifications
License, Registration, Certification Date Received Expiration Date Licensing Agency
Pick a date Pick a date
Pick a date Pick a date
   
Skills & Abilities
Please list any special knowledge, skills, or abilities that may be relevant to the position that you are seeking such as computer skills, equipment operation, fluency in languages, etc.
Please check any computer skills that may apply
Microsoft Word
Microsoft Excel
Microsoft Publisher
Microsoft Outlook
Microsoft PowerPoint
Microsoft Access
Adobe Acrobat
Internet Explorer
Great Plains
Kronos Timekeeper
Other:
   
Required *
References
Name Occupation Phone Number
 
Employment
List positions starting with most recent:
Employment:
Telephone:
Address:
Position Title:
Supervisor:
Start Date: Pick a date End Date: Pick a date
Salary:
Duties:
Reason for Leaving:
   
Employment 2:
Telephone:
Address:
Position Title:
Supervisor:
Start Date: Pick a date End Date: Pick a date
Salary:
Duties:
Reason for Leaving:
   
Employment 3:
Telephone:
Address:
Position Title:
Supervisor:
Start Date: Pick a date End Date: Pick a date
Salary:
Duties:
Reason for Leaving:
   
Résumé Information
Attach Résumé:
   

STATEMENT (Please read this statement carefully before signing this application):

I understand that employment with Virginia Lutheran Homes, Inc. is at-will, meaning that I or the Company may terminate my employment at any time, or for any reason consistent with applicable state or federal law.

I authorize Virginia Lutheran Homes to make a thorough pre-employment investigation and release all persons, companies, or corporations, including Brandon Oaks, its employees, and officers and agents, from liability for supplying and receiving information as may be requested. I agree to cooperate with Virginia Lutheran Homes concerning pre-employment inquiries, including but not limited to background checks and criminal record checks. I certify that the statements in the application are true to the best of my belief. I understand that false statements may result in immediate discharge, as well as any penalties where appropriate. I understand that nothing in this application is intended to create a contract, either expressed or implied, for any specific duration.

I understand that the Company requires the successful completion of a drug and/or alcohol test and a thorough criminal background investigation as a condition of employment.

I understand this application will be active for a period of 6 months; after that time if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.

 
I agree to the above statement and hereby submit my application for employment.
 
 
   
 
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Virginia Lutheran Homes | Phone: 540-562-5443 Disclosure Statement.

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