Request edit access
McConaughy Discovery Center
Employment Application
401 North Spruce Street
PO Box 299
Ogallala, NE 69153
Office: 308-284-4491 Fax: 800-610-5972
hr@mdcenters.net
Email address *
An Equal Opportunity Employer
McConaughy Discovery Center is an equal opportunity employer. This application will not be used for 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 *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Street Address/ PO Box *
Your answer
City, State, Zip *
Your answer
Cell Phone/ Home Phone *
Your answer
How were you referred to McConaughy Discovery Center? *
Your answer
Have You Lived outside of the state of Nebraska within the last two years? *
If Yes, please list the state(s):
Your answer
Are you a US Citizen or otherwise authorized to work in the US on an unrestricted basis (You may be required to provide documentation) *
Employment Positions:
Position(s) Applying for: *
Your answer
Please check the boxes that you are willing to work. *
Required
What days are you available to work? *
Required
What hours are you available to work? *
Your answer
Can you work evenings? *
Can you work Holidays? *
Are you available to work overtime? *
If hired, what date can you start working? *
MM
/
DD
/
YYYY
Salary Desired: *
Your answer
Personal Information:
Have you ever applied to/ worked for this company before? If yes, please explain (include date): *
Your answer
Do you have any friends, relatives or acquaintances working for this company? If Yes, state name & relationship: *
Your answer
If hired, would you have transportation to/from work? *
If hired, are you willing to submit to and pass a controlled substance test? *
Do you have a Nebraska driver's license? *
Do you have a cell phone for work use? *
Do you have internet access for our documentation requirements? *
Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? If no, describe the functions that cannot be performed. *
(Note: Company complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/ employees to perform essential functions. It is possible that a hire may be tested on skill/ agility and may be subject to a medical examination conducted by a medical professional.)
Your answer
Education and Training:
High School- Name/ Address, years completed, major and degree earned: *
Your answer
Business/ Trade/ Technical- Name/ Address, years completed, major and degree earned:
Your answer
College/ University- Name/ Address, years completed, major and degree earned:
Your answer
Graduate/ Professional- Name/ Address, years completed, major and degree earned:
Your answer
Work Experience:
Most Recent Employer *
Employer Name
Your answer
Dates Employed: *
Your answer
Address: *
Your answer
Supervisor name and phone number: *
Your answer
Describe work performed: *
Your answer
Reason for leaving: *
Your answer
Previous Employer *
Employer Name:
Your answer
Dates Employed: *
Your answer
Address: *
Your answer
Supervisor name and phone number: *
Your answer
Describe work performed: *
Your answer
Reason for leaving: *
Your answer
Previous Employer: *
Employer Name:
Your answer
Dates Employed: *
Your answer
Address: *
Your answer
Supervisor Name and phone number: *
Your answer
Describe work performed: *
Your answer
Reason for leaving: *
Your answer
References:
Name and Relationship: *
Your answer
Phone Number: *
Your answer
Name and Relationship: *
Your answer
Phone Number: *
Your answer
Name and Relationship: *
Your answer
Phone Number: *
Your answer
Applicant Statement
I certify the information contained in this application is true, correct and complete. I understand that if employed, false statements reported on this application may be considered sufficient cause for dismissal. I authorize the investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I hereby give McConaughy Discovery Center permission to obtain references regarding my abilities and qualifications for employment, background checks and release reference sources from liability concerning information on reference.
I understand that employment with this company is "at-will", which means that either I or the company can terminate the employment relationship at any time, with or without prior notice and for any reason not prohibited by statute. All employment is continued on that basis, I understand that no supervisor, manager or executive of this company, other than the CEO, has any authority to alter the foregoing.
I certify I have never been convicted of a crime involving mistreatment or exploitation of a child. *
I certify I have never been involved in any type of Child/Adult abuse. *
Have you ever been convicted of a crime in this state or any other- felony or misdemeanor? (Not including traffic violations) *
If you answered yes above, please explain:
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)
Your answer
Terms of Acceptance and Signature
I, the applicant for this application, warrant the truthfulness of the information provided in this application.
Electronic Signature: *
Please type your First and Last Name
Your answer
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. *
Required
Next
Never submit passwords through Google Forms.
This form was created inside of mdcenters.net. Report Abuse - Terms of Service