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Heritage Communities
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Submit a General Application

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

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General Information
* First Name:
* Last Name:
Address 1:
Address 2:
* City:
* State:
Zip Code:
* Phone:
Applicants - Please include your Email for communications. Associate making Referrals - If Email is unknown leave blank.
Start Date Availability:
Pay rate desired:
If applying for volunteer opportunities leave blank
Types of employment preferred:
* Were you referred by a current employee: Yes    No   
Application Information
Referred By:
Yes   No
Yes   No
Yes   No
Yes   No

Tell us the highest level of education you have completed that applies to this position.

Yes   No
High School Diploma/GED

List your most recent employer. (If none, leave blank.)

Employer 1


The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

Heritage Employment/Volunteer Interest Form
Let us know what types of positions you are interested in!
What types of Opportunities are you interested in?
* When would you be looking to start?
1-2 months from now
2-3 months from now
3-5 months from now
6+ months from now
* In what departments are you interested in working OR volunteering?
Accounting and Finance
Dining Services
Human Resources
Life Enrichment
Nursing / Caregiving
Sales and Marketing
* Please indicate any type of License OR Certifications that you currently have relevant to the opportunity you are interested in.
Certified Medication Aide/Tech (CMA/CMT)
Certified Nursing Aide (CNA)
Certified Medication Tech
Certified Caregiver
I have a license but it is not current/active.
I am currently working on obtaining a certification.
If you selected "Other" enter any license or certification you currently hold. (leave blank if nothing).
* Which shifts/hours are you available to work?  Select all that apply.
* Are you available to work weekends?
* What locationd are you most interested in working?
Arizona - Orchard Pointe at Arrowhead - 17200 N. 67th Ave, Glendale
Arizona - Orchard Pointe at Surprise - 15048 W. Young St, Surprise
Arizona - Orchard Pointe at Terrazza - 6775 W. Happy Valley Rd, Peoria
Iowa - The Heritage at Fox Run - 3121 Macineery Dr, Council Bluffs
Iowa - The Heritage at Northern Hills - 4002 Teton Trace, Sioux City
Nebraska - Heritage Ridge - 1502 Fort Crook Rd, Bellevue
Nebraska - The Heritage at Meridian Gardens - 4515 38th St, Columbus,
Nebraska - The Heritage at Shalimar Gardens - 749 E. 29th St, Fremont
Nebraska - The Heritage at Sagewood - 1920 Sagewood Ave, Grand Island
Nebraska - The Heritage at College View - 1100 N. 6th Ave, Hastings
Nebraska - The Heritage at Fountain Point - 3725 Madison Ave, Norfolk
Nebraska Heritage Communities Home Office - 16934 Frances, Omaha
Nebraska - OnCare Home Health - 16934 Frances St, Suite 200, Omaha
Nebraska - Heritage Pointe - 16811 Burdette St, Omaha
Nebraska - The Heritage at Legacy - 2961 S. 169th Plz, Omaha
Nebraska - The Heritage at Sterling Ridge - 1111 Sterling Ridge Dr, Omaha
* What is the best way to contact you regarding a career opportunity?
Equal Opportunity Employment
If you are an Associate Referring someone please select "Choose Not to Respond" to the following questions.

We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
I Choose Not to Respond
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Individual with a Disability
An individual with a disability is a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities, or who has a record of such impairment.
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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