Careers Form - Langdon Prairie Health

Your Imformation

Position applying for:(Required)

First name:(Required)

Last name:(Required)

Email:(Required)

Phone(Required)

Previous employment at Langdon Prairie Health? *(Required)

If yes, what position(s) did you hold and when?

HIGH SCHOOL EDUCATION

Name and location:(Required)

Years completed:(Required)

Did you get your diploma?(Required)

COLLEGE/VOCATIONAL OR TECHNICAL SCHOOL

School #1 - Name and location:

Course of Study:

Degree:

School #1 - Name and location:

Course of Study:

Degree:

LICENSURES AND CERTIFICATION: (if applicable to position)

Title #1:

Title #2:

Number:

Expiration:

LICENSURES AND CERTIFICATION:
(if applicable to position)

Company name #1:

Primary duties:

Address

Reason for leaving:

Phone

Date employed from:

Position held:

Date employed to:

Company name #2:

Primary duties:

Address

Reason for leaving:

Phone

Date employed from:

Position held:

Date employed to:

Company name #3:

Primary duties:

Address

Reason for leaving:

Phone

Date employed from:

Position held:

Date employed to:

RELATED SKILLS, EDUCATION &/OR ACTIVITIES:
(if applicable to position applying for)

RELATED SKILLS, EDUCATION &/OR ACTIVITIES:

LICENSURES AND CERTIFICATION: (if applicable to position)

Please list 2 work references & 1 personal reference

Name #1:

Address:

Phone:

Relationship:

Name #2:

Address:

Phone:

Relationship:

Name #3:

Address:

Phone:

Relationship:

Please upload your resume if available

Accepted file types: jpg, png, pdf, Max. file size: 256 MB.

The facts set forth in this application are true and complete to the best of my knowledge. I understand that if employed, any false statement on this application may result in dismissal.

I understand it is Langdon Prairie Health policy to verify past employment, check work-related references, licensure verification and where regulated by state statute, conduct criminal background checks on prospective employees.

I consent to the release of information concerning my capacity and/or all aspects of prior job performance by employers, educational institutions, law enforcement agencies, state licensing boards and other individuals and agencies to duly accredited investigators, human resource staff and other authorized employees of Langdon Prairie Health. I waive any action against Langdon Prairie Health or former employers based on statements made during these investigations.

By pressing the submit button below I hereby certify that I have read and understand the above statement and that the information provided herein is complete and factual.

Careers

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Your Imformation

HIGH SCHOOL EDUCATION

COLLEGE/VOCATIONAL OR TECHNICAL SCHOOL

LICENSURES AND CERTIFICATION: (if applicable to position)

LICENSURES AND CERTIFICATION: (if applicable to position)

RELATED SKILLS, EDUCATION &/OR ACTIVITIES: (if applicable to position applying for)

LICENSURES AND CERTIFICATION: (if applicable to position)

LICENSURES AND CERTIFICATION:
(if applicable to position)

RELATED SKILLS, EDUCATION &/OR ACTIVITIES:
(if applicable to position applying for)