Bethel Lutheran Nursing and Rehabilitation Center Employment Application
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Employment Online Application

Bethel Lutheran Nursing & Rehabilitation Center is an equal opportunity employer. This application will not be usedfor limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization.
* First Name:
Middle Initial:
* Last Name:
* Address:
* City:
* State:
* Zip:
* Phone:
* Date Available:
* Position Requested:

* Hours/Days/Shifts You are UNABLE to Work:
* How were you referred to Bethel Lutheran Nursing & Rehabilitation Center:
* Are you at least 16 years of age:

* Have you ever applied to/worked for Bethel Lutheran Nursing & Rehabilitation Center before:
If yes, please explain (include dates):

* Have you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation:
If yes, please explain (include the date of final disposition of the case and the nature of the offense):

This information will not necessarily disqualify you from employment but false or misleading information will. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.
List All Professional License, Certificates or Permits:
Name State Number Expiration Date

* Have you ever had a professional license disciplinary action, or has your license ever been revoked, suspended, restricted or modified in any state?
If yes, please attach full details.

If you do not have a required registration or license, have you applied for one?

If an examination is required, what date are you scheduled to take the examination?

If not licensed in North Dakota, have you applied for reciprocity?