Employment Application 

We're excited that you are interested in a position with Salem Mennonite Home. Everything we do is to enhance the life of our residents! If you are a patient, compassionate, empathetic, reliable, committed, and honest team player, we encourage you to apply by completing the following form.

You may also download an employment application by clicking here. 

Name *
Name
Firs and Last Name
Date *
Date
Please let us know which position you are interested in
Phone Number *
Phone Number
Current Address *
Current Address
How long have you lived at your current address?
Are you over the age of 16?
Are you a United States citizen or resident alien with a visa allowing you to work?
What is the job you are applying for?
Rate of pay expected per hour
What are you interested in working
Availability *
When are you available to work? Select all that apply.
Are you currently employed?
Do you have a financial interest in any business or plan to hold another job while working for Salem Mennonite Home?
If you have financial interest in any business or plan to hold another job while working for Salem Mennonite Home, please explain
Are you related to anyone currently working here? If so, whom. If none, answer NA.
In case of emergency notify (include name, address and phone number)
Do you have transportation to and from work?
Can you perform the job duties for the position for which you are applying?
Have you ever been convicted of a felony crime? SMH will conduct a background check to screen for abuse, neglect, and exploitation for all employees that provide direct services or supports. The facility will not knowingly employ any person with a conviction for abusing another person.
Include name of school, school address, course of study, grade completed, year graduated and degree earned.
Include name of school, school address, course of study, grade completed, year graduated and degree earned.
Include name of school, school address, course of study, grade completed, year graduated and degree earned.
List your most recent employer information including: 1. Start date and pay rate 2. Name address and phone number of employer 3. Supervisor's name and title 4. Termination date, pay rate and reason for leaving 5. Describe in detail the work you did there
List your most recent employer information including: 1. Start date and pay rate 2. Name address and phone number of employer 3. Supervisor's name and title 4. Termination date, pay rate and reason for leaving 5. Describe in detail the work you did there
List your most recent employer information including: 1. Start date and pay rate 2. Name address and phone number of employer 3. Supervisor's name and title 4. Termination date, pay rate and reason for leaving 5. Describe in detail the work you did there
May be contact the employers listed above? If no, indicate which you do not wish us to contact.
For the purpose of verifying education, professional and employment records, please state any name by which you have been known other than the name under which you are applying.
List the name, phone number and relationship of your first reference.
List the name, phone number and relationship of your second reference.
Please read carefully. By submitting this online application form you: Certify that the facts in this application are true and correct to the best of my knowledge and I understand that any misrepresentation or willful omission of facts shall be cause of rejection of this application or termination of my employment. I hereby authorize the Salem Mennonite Home to conduct a thorough investigation of my past employment, education, job-related activities and personal references. To the extent permitted by law, I hereby release the Salem Mennonite Home from any liability that may result from making such an investigation and I also release from any liability all persons and entities supplying such information. I understand and agree that as condition of my employment I may be required to submit to such physical examination as may be required. Answer Yes below if you understand.
Resume *
In addition to my completed application above, I will be emailing my resume to office@salemmennonitehome.com

Provisions of the Fair Credit Reporting Act require that we advise you that a routine inquiry may be made which will provide information concerning your character, reputation, personal characteristics and mode of living. If such inquiry is made, you may obtain additional information as to the nature and scope of the report upon written request.