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Coburg Village Employment Application

You must complete and submit your application in one session. Your answers will not be stored in the form.

You will receive a confirmation email when your application is successfully submitted. 

We are an Equal Opportunity Employer 

We do not discriminate on the basis of actual or perceived race, religion, sex, age, national origin, sexual preference, disability, or any other status protected under Federal, State, or local laws and regulations. The Lutheran Care Network (TLCN) is committed to the policy of equal employment opportunity in recruitment, hiring, career advancement, and all other employment practices.


Personal Information

Country
Address Line 1 *
City *
State/Province *
Postal Code *
Are you 18 years of age or older?
Are you legally authorized to work in the U.S.?
Will you be able to provide proof within three days of employment?
Are you related to an officer or employee of Coburg Village or The Lutheran Care Network?
First and Last Name
First Name
Last Name
Were you previously employed by Coburg Village or the Lutheran Care Network?

Education

Diploma or Degree Received:
Diploma or Degree Received:
Diploma or Degree Received:
Diploma or Degree received

Foreign Languages


Licenses and/or Certifications

Employment History

Status
Country
Address Line 1
City
State/Province
Postal Code
Status
Country
Address Line 1
City
State/Province
Postal Code
Country
Address Line 1
City
State/Province
Postal Code

Professional References

First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code

Military Record in the U.S. Armed Forces

Have you ever been excluded from participating in a Federal Healthcare Program? Any plan or program that provides health benefits whether directly, through insurance or otherwise, which is funded directly through insurance in whole or part by the United States Goverment?
Are you able , as far as you know, to perform all of the essential functions of the job(s) you are applying for, with or without reasonable accommodations?

Additional Documentation

No file selected

No file selected

Certification

By signing this application I certify that the information I have provided to the foregoing questions is true and correct to the best of my knowledge and belief, and that no attempt has been made to conceal information. Furthermore, I authorize my former and present employers, schools, and personal references to provide any information they have regarding me, whether or not it is on their records. I hereby release them and The Lutheran Care Network to the fullest extent from all liability for divulging the requested information. I understand that if any information given by me in this application and/or the attached resume is found to be false or misleading, I will be subject to dismissal at anytime during the period of my employment.

If employment is obtained under this application, I will comply with all rules, regulations, policies, and procedures of The Lutheran Care Network (TLCN). I agree to be responsible for all property and equipment issued to me by TLCN  until it is returned by me. I agree to submit to any/all physical examination(s) by TLCN and understand that my employment is contingent upon a satisfactory medical clearance, and Chauncey, Office of Inspector General (OIG), National Practitioner Data Bank (NPDB), Office of the Professions (OP), and/or any other applicable accrediting agency's databank search. Further, I understand and agree that unless my position is covered by a collective bargaining agreement or other written employment agreement that my employment is at will and for no definite period of time, and may be terminated at any time with or without cause or prior notice by TLCN or myself. I further understand that this at will employment relationship may not be changed by any written document or by conduct unless

By signing this application I certify that the information I have provided to the foregoing questions is true and correct to the best of my knowledge and belief, and that no attempt has been made to conceal information. Furthermore, I authorize my former and present employers, schools and personal references to provide any information they may have regarding me, whether or not it is on their records. I hereby release them and The Lutheran Care Network to the fullest extent from all liability for divulging the requested information. I understand that if any information given by

me in this application and/or the attached resume is found to be false or misleading, I will be subject to dismissal at anytime during the period of my employment.

 

 

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Coburg Village is a part of The Lutheran Care Network a ministry of healing, hospitality and community through partnerships in caring. The Lutheran Care Network is committed to the physical, emotional and spiritual needs of seniors.
  • Coburg Village is a part of The Lutheran Care Network a ministry of healing, hospitality and community through partnerships in caring. The Lutheran Care Network is committed to the physical, emotional and spiritual needs of seniors.