Employment Application

Northeast Iowa Area Agency on Aging non-discrimination policy
No person shall be discriminated against in employment or provision of services on the basis of race, national or ethnic origin, age, gender, sexual orientation, gender identity, marital status, veteran status, religion, creed, disability or other characteristic protected by law.  
NEI3A is an Equal Opportunity Employer

If you need assistance to fill out this application form, or any part of the application, interview or employment process, please email HR@nei3a.org or call 319-874-6846.

All fields marked with an * are required.

Personal Information



  • You will be required to provide documentation should you be employed.

Applicant's Statement

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

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby release from all liability or damage those individuals, corporations or organizations who provide such information.

This application for employment shall be considered active for a period of time not to exceed ninety (90) days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an ‘at will’ nature, which means that the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this ‘at will’ employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. I agree that the company shall not be liable in any respect if my employment is terminated because of falsity of statement, answers or omissions made by me on this application.

I acknowledge that NEI3A is required to conduct a criminal history, child and dependent adult abuse record check for persons employed by Northeast Iowa Area Agency on Aging. A background check will be conducted prior to confirming a conditional job offer.

Northeast Iowa Area Agency on Aging
PO Box 388
Waterloo, IA 50704

This application will be retained for ninety (90) days.

Education




Work Experience


Current Employer (or most recent employer)
  •  (mm/yyyy)
  •  (mm/yyyy)

  • $
Previous Employer 1
  •  (mm/yyyy)
  •  (mm/yyyy)

  • $
Previous Employer 2
  •  (mm/yyyy)
  •  (mm/yyyy)

  • $

Employment Information

 (mm/dd/yyyy)

  • (Conviction will not necessarily disqualify an applicant from employment.)



Professional References

Reference 1
Reference 2
Reference 3

Optional Resumé Upload

  • (Please submit a single PDF or Microsoft Word file)

By checking this box and submitting this electronic application, I understand that NEI3A is required to conduct a criminal history, child and dependent adult abuse record check for persons employed by Northeast Iowa Area Agency on Aging. A background check will be conducted prior to confirming a conditional job offer.

Yes, I agree.
Call 1-800-779-8707 or complete a Request for Information

Empowering you to age with confidence.