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Job Application
Employment Application
Job Posting
Select Posting to Apply for:
- Select Posting to Apply for -
Submit Application - not a specific job
823 - LPN - Specialty Clinic - Relief
845 - Surgical Technologist - Full Time
962 - Registered Nurse - Surgery Supervisor - Full Time
966 - Radiology Ultrasound Technologist - General/Vascular Tech -Relief
969 - Radiology Tech - CT Tech - Full - Part or Relief
978 - LPN - MSP - Full or Part Time
991 - CRNA - Certified Registered Nurse Anesthetist - Full Time
1020 - Home Connections - Home Health Aide - Full Time
1026 - Sodexo - Evening Dishwasher/Tray Runner
1044 - Sodexo - Food Service Worker
1090 - Registered Nurse - Cancer Center - Relief
1092 - Registered Nurse - Dialysis - Ortonville Unit - Full Time
1112 - Physical Therapist - Full Time
1119 - Registered Nurse - Admitting - Recovery - Relief
1126 - Sodexo - Lead Worker -Food Services
1129 - Physical Therapist - Relief
1131 - Admitting Clerk - Business Office - Part -Time
1153 - Sterile Process Technician - Full-Time
1154 - Certified Maintenance Technician - Full Time
1155 - Registered Nurse - Dialysis - Full Time – Wtn Dialysis Unit
1156 - Social Worker - Relief
1166 - Registered Nurse - Maternal Child Health - Full Time
1168 - Registered Nurse - SDS - Part Time
1170 - Registered Nurse - CCU - Full or Part-Time
1171 - Telemetry Tech - Part Time
1173 - Registered Nurse - MSP - Full Time
1174 - Financial Analyst - Full Time
1175 - Registered Respiratory Care Practitioner or Certified (CRT) considered
1176 - LPN - MA Outreach Clinic
1177 - Registered Nurse - Emergency Services - Full Time
1179 - Sodexo - Housekeeping Night Shift Full Time
1181 - Sodexo Night Shift Custodian Full - Time
1182 - Radiology - Ultrasound Technologist - Full Time
1183 - Business Office Specialist - Clinic Support
1184 - Central Scheduling Scheduler - Full Time
1185 - Radiology Technologist - Relief
Referral
Referred by:
- How did you hear about the job you are applying for? -
Newspaper
Employee
Internet
Physician
School
Recruiting Fair
Walk In
Radio / TV
Other
Prairie Lakes Website
* Required fields are in red
Personal Information
First Name*:
Middle Name:
Last Name*:
Home Phone*:
Cell/Work Phone:
Email Address*:
Addresses
Current Address
Street*:
City*:
State*:
Zip Code*:
Education
Formal Schooling
School:
City:
State:
Diploma:
No
Yes
Deg/Cert/Dip:
Area of Study:
Employment Information
Employment Information
Position Applied For:
Date available:
(yyyy-mm-dd)
Minimum Salary Desired ($):
Do You Prefer:
Full-Time
Part-Time
Either
Shift Desired:
Days
Evening/Night
Days Available:
M
Tu
W
Th
F
Sa
Su
Are you currently employed?:
No
Yes
Please answer all of the following questions.
1) Are you a U.S citizen?
No
Yes
If not, do you have a legal right to work in the U.S.?
No
Yes
2) Have you ever been employed at Prairie Lakes Healthcare System before?
No
Yes
If yes, where?:
3) Are you at least 18 years of age?
No
Yes
4) Do you understand the job requirements?
No
Yes
5) Have you ever been discharged or forced to resign from any position?
No
Yes
If yes, explain:
Employment History
May your past employer(s) be contacted for job references?
No
Yes
May your present employer be contacted for job references?
No
Yes
Current Employer (if applicable)
Company Name**:
City**:
Zip Code**:
Phone**:
Position Held**:
From (m/d/yyyy)**:
To (m/d/yyyy)**:
Salary**:
Supervisor**:
Email**:
Reason For Leaving**:
Prior Employer*
Company Name*:
City*:
Zip Code*:
Phone*:
Position Held*:
From (m/d/yyyy)*:
To (m/d/yyyy)*:
Salary*:
Supervisor*:
Email*:
Reason For Leaving*:
Prior Employer*
Company Name*:
City*:
Zip Code*:
Phone*:
Position Held*:
From (m/d/yyyy)*:
To (m/d/yyyy)*:
Salary*:
Supervisor*:
Email*:
Reason For Leaving*:
Prior Employer*
Company Name*:
City*:
Zip Code*:
Phone*:
Position Held*:
From (m/d/yyyy)*:
To (m/d/yyyy)*:
Salary*:
Supervisor*:
Email*:
Reason For Leaving*:
Other Details
Job Related Details
Answering yes to the next question does not constitute an automatic bar to employment. Factors such as date of the offense, age at time of offense, seriousness and nature of violation, and rehabilitation, as well as position applied for will be taken into account.:
1) Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?
No
Yes
If yes, please provide date(s) and details. You do not need to provide information regarding sealed, expunged, or statutorily eradicated convictions.
2) Have you ever been convicted of a felony charge?
No
Yes
3) List any military experience which may be related to the job for which you are applying:
Skills
Professional Designations
Professional References
Reference
Name*:
Company Name & Address*:
Telephone*:
Email Address*:
Present Title*:
Reference
Name*:
Company Name & Address*:
Telephone*:
Email Address*:
Present Title*:
Reference
Name*:
Company Name & Address*:
Telephone*:
Email Address*:
Present Title*:
Resumes
Upload File
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.
Security Code
Security Code
enter the above security code
Signature
Type Name in Signature Box*:
Notice: please click on the submit button only once.
Date:
10-07-2022 10:15:02
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