Employment Application


Job Posting Select Posting to Apply for: 
Referral Referred by: 
* Required fields are in red

Personal Information

Addresses

Current Address

Education

Formal Schooling

Employment Information

Employment Information
 (yyyy-mm-dd)
 Days  Evening/Night
 M  Tu  W  Th  F  Sa  Su
Please answer all of the following questions.
1)  Are you a U.S citizen?
If not, do you have a legal right to work in the U.S.?
2) Have you ever been employed at Prairie Lakes Healthcare System before?
If yes, where?:
3) Are you at least 18 years of age?
4) Do you understand the job requirements?
5) Have you ever been discharged or forced to resign from any position?
If yes, explain:

Employment History

May your past employer(s) be contacted for job references?
May your present employer be contacted for job references?
Current Employer (if applicable)
Prior Employer
Prior Employer
Prior Employer

Other Details

Job Related Details

Professional References

Reference
Reference
Reference

Resumes

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Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt,rtf - Max file size: 3145728 bytes)

Certification and Authorization

Statement
1. I hereby certify that the statements contained in this application are true and correct to the best of my knowledge and belief.
2. I hereby authorize Prairie Lakes Healthcare System (PLHS) to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.
3. I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, regardless of time of discovery.
4. I understand that any employment here is contingent on the results of a physical capacity assessment if required. I understand that if I am hired by PLHS my employment will be for an indefinite period of time and will be "at will" which means that either I or PLHS may terminate the employment relationship at any time and for any or no reason. Finally, I also understand that while PLHS supports current policies and benefits, it retains the right to change them at any time, with or without notice. PLHS is committed to providing a safe, healthy, and productive work environment and supports a smoke free, alcohol and drug free work environment.
5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
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Signature
 
Type Name in Signature Box*:
 
 
Date: 12-09-2018 21:04:28

Prairie Lakes Healthcare System is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to age, race, color, religion, sex, national origin, disability or protected veteran status. If you’d like more information about your EEO rights as an applicant under the law, please click here.