1-402-375-4770
1320 E 7th St, Wayne, NE 68787

    EMPLOYMENT APPLICATION
    Personal Information
    We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, handicap or national origin.
    Name:
    		Phone:
    Last First MI
    Address:
    Street City State Zip
    Email: Are you 18 Years of Age or Older? YesNo
    Employment Desired
    Available Date: Are you currently employed? YesNo
    Preferred Position: If so, may we contact your employer? YesNO
    Desired Salary: Have you worked for Heritage before? YesNO
    If so, when?
    Referral Source
    How did you hear about our Employment Opportunities? (Select all that apply) Newspaper Radio Social Media Walk-In
    Heritage Employee
    Other
    General
    Job Related Skills and Training (typing, driver’s license, forklift operator, OSHA 10 hour, etc.)
    Former Employers
    List Below your last four employers, starting with the last one first.
    Date Name, Address Of Employer Salary (Upon Leaving) Position Reason for Leaving
    Month and Year
    From
    To
    From
    To
    From
    To
    From
    To
    Education
    High School or GED Name and location of School Subjects Studied and Degree Received
    College
    Trade, Business or Correspondence School
    References
    List below three persons not related to you, whom you have known at least one year.
    Name Phone Number Relation Years Acquainted
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    If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

    APPLICANT'S CERTIFICATION AND AGREEMENT
    I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Heritage to verify their accuracy and to obtain reference information on my work performance. I hereby release Heritage from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that filling out this form does not indicate there is a position open and does not obligate Heritage to hire. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. Heritage reserves the right to revise its policies or procedures, in whole or in part, at any time. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause.