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Employment Application

About Us

Passion. That’s the common attribute of those that work for our organization.

We are dedicated to helping the people who utilize our services. If you’re ready to make a difference, browse our openings or upload your resume and tell us your interests. We’ll consider you for future opportunities.


Application

Personal Information

Education Information
Please list your High School/G.E.D. name, location, if you graduated, and your graduation year.
Please list your trade/business school name, location, if you graduated, year you graduated, and your major/degree.
Please list your college name, location, if you graduated, year you graduated, and your major/degree.
Please list your graduate school name, location, if you graduated, year you graduated, and your major/degree.

Other Information
If yes, identify the crime for which you were convicted, the dates of the conviction and the location of the court in which you were convicted. Please provide any details you feel are relevant. Conviction of a crime will not automatically disqualify you from consideration for employment, but will be considered as part of an overall evaluation of your qualifications. However, failure to list any convictions may be considered as falsifying your application.

Military Service Record
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If no, Please explain the circumstances

Employment History
Job #1
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Job #2
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Job #3
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General Information
How were you referred to Nebraska Urban Indian health Coalition? Check all that apply

References
Name, Address, Phone Number, Occupation, Years Known
Name, Address, Phone Number, Occupation, Years Known
Name, Address, Phone Number, Occupation, Years Known

Attachments Required

Certification and Agreement

I understand and agree that:

  1. Any misrepresentation or omission of facts in my application or any attachments to my application will result in refusal of employment or if employed, termination from employment.
  2. It is my understanding that the Nebraska Urban Indian Health Coalition will make a thorough investigation of my work, educational and personal history and may verify all data given in my application, related papers or oral interviews. I authorize such investigation and the giving and receiving of any information requested by NUIHC, and I release from liability any person giving or receiving any such information. I understand that falsification will result in refusal of employment or, if employed, termination from employment.
  3. I understand and agree that I will be required to take a pre-employment drug test at NUIHC expense, in addition to random or for cause testing, during my employment to determine if I am alcohol or drug free for the job I am responsible to perform. Failure to submit to such testing will result in termination.
  4. I authorize any physician, including my personal physician, to release any information to NUIHC, which may be necessary to determine my ability to perform my assigned duties.
  5. I agree to conform to all applicable rules, regulations, policies, and/or disciplinary procedures or NUIHC and/or any department thereof. I understand that those rules, regulations, policies and/or disciplinary procedures are not intended by NUIHC to create an obligation of continued employment.
  6. I understand that this document is an application for employment and continued employment is not being offered. I hereby understand and agree that my employment, both during and after introductory period, and that nothing in this application or any other NUIHC document shall be deemed to create any contract of continued employment between me and NUIHC. I understand that my employment beyond any introductory period or employment for a number of years shall not result in my heightened expectation of continued employment. I understand and agree that any statements to the contrary, whether oral or written, are expressly disavowed and are not to be relied upon by me.
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