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About
Services
Calendar
- Activities
- Menu
Contact
Employment

Admission Inquiries

Employment Application

Take the first step toward a rewarding career by applying to join our compassionate team dedicated to exceptional care

How to Apply

Paper application forms are available for pickup at Platte County Legacy Home. Applicants may also choose to complete and submit the application online using the form below.

Your Information

Applicant Information

First Name *

Last Name *

Street Address *

Address Line 2Apartment, suite, etc

City *

State *

ZIP Code *

Phone Number *

Email Address *

Date of Birth *

Date Available *

Desired Salary *

USD

Position Applied For *

Are you a citizen of the United States? *YesNo

Are you authorized to work in the United States? *YesNo

Have you ever worked for this company? *YesNo

If yes, when?

Are you currently employed? *YesNo

If yes, may we contact your current employer?YesNo

What type of employment are you seeking? *Full-Time (32+ hours per week)Part-Time (24-31 hours per week)PRN (minimum 2 shifts per month required)

Preferred shift: *DayEveningNightAny

Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations? *YesNo

If no, please describe the function that CANNOT be performed.

Have you ever been convicted of a criminal offense? *YesNo

If yes, state the nature of the criminal offense, when, where, and the disposition of the case.

List any licenses or certifications you have.Please write the state in which you are currently licensed, as well as previous states where you have been licensed.

Have you ever served in the military? *YesNo

If yes, please list the branch, dates of service, rank at discharge, and type of discharge.If not an honorable discharge, please explain.

Upload Resume / CVPlease upload your resume / CV. | Allowed File Types: PDF, DOC, DOX. Maximum File Size: 200MB.

No file chosen

Upload Cover LetterPlease upload your cover letter. | Allowed File Types: PDF, DOC, DOX. Maximum File Size: 200MB.

No file chosen

Education & Work History

High School Education

High School Name *

Address *

From: *

To: *

Did you graduate? *YesNo

Diploma

College / University

College / University Name

Address

From:

To:

Did you graduate?YesNo

Degree

Technical School / Other School

Technical School / Other School

Address

From:

To:

Did you graduate?YesNo

Degree

Previous Employer 1

Company *

Job Title *

Address *

Phone *

Supervisor Name *

May we contact your previous supervisor for a reference? *YesNo

From: *

To: *

Starting Salary *

USD

Ending Salary *

USD

Reason for Leaving *

Responsibilities *

Previous Employer 2

Company

Job Title

Address

Phone

Supervisor Name

May we contact your previous supervisor for a reference?YesNo

From:

To:

Starting Salary

USD

Ending Salary

USD

Reason for Leaving

Responsibilities

Previous Employer 3

Company

Job Title

Address

Phone

Supervisor Name

May we contact your previous supervisor for a reference?YesNo

From:

To:

Starting Salary

USD

Ending Salary

USD

Reason for Leaving

Responsibilities

Acceptance of Terms

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading in my application or interview may result in my release.

Signature *

Today's Date *

Please read and check each paragraph, and then sign below.

Authorization to Investigate *

I authorize any person (s) or organization (s) referenced in this application to give the company any and all information concerning my previous employment, education, or other information they might have, with regard to any subjects covered by this application, and release all such parties from the liability for any damage that may result from furnishing such information. I authorize the company to request and receive such information.

At-Will Relationship *

I understand and agree that if I an offered employment with the company it will be on an "at-will" basis. This means that either I or the company may terminate the employment relationship at any time for any reason, with or without cause. I further understand that the "at-will" nature of my employment with the company is an aspect if employment that cannot be modified or changed, except by a written agreement signed by the chief executive officer of the company. I understand that nothing contained in this application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create and employment contract between me and the company.

Search of Public Records *

I understand and agree that a background check will be performed by the company as part of the hiring process. I authorize the company to conduct this background check and acknowledge that I must provide a valid email address to be used for this purpose. I understand that I am entitled to request a copy of any records obtained as a result of this background check.

Background Check Email *

Confirm Email Address *

Drug & Alcohol Testing *

If offered employment I agree to submit to a drug and alcohol test before starting work. If employed, I also agree to submit to drug and alcohol test at any time deemed appropriate by the company and as permitted by law. I understand the results of these tests will remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory drug and alcohol tests, and if I am hired a condition of my employment will be that I abide by the company's Drug and Alcohol Policy.

Policies *

If hired, I agree to abide by all company work rules, policies and procedures. The company retains the right to revise it policies and procedures, in whole or in part, at any time.

Obligation to Hire *

I understand that filling out this form does not indicate there is a position open and does not obligate the company to hire me.

Signature *

Today's Date *

Are you under the age of 18? *NoYes

Parent/Guardian Authorization

As the parent or guardian of the above applicant (who is a minor), I similarly authorize [EMPLOYER] to receive "consumer reports" and "investigative consumer reports" about the above applicant as described above.

Signature of Parent/Guardian of Applicant *

Today's Date *

At Platte County Legacy Home, we strive to provide a continuum of excellent care and service to the aging in a spirit of love, respect, and compassion.

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Phone: (307) 322-7400
Fax: (307) 322-7435
Address: 100 19th St,
Wheatland, WY 82201

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