Do I Qualify
Qualifying Criteria
Registration Process
Who is a Health Care Provider
Health Benefits
About Us
Careers
Contact Us
FAQ
Available Products
Apply Now
Personal Information
*
Indicates required field
First Name
*
Email
*
Middle Initial
*
Phone
*
Last Name
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Position of Interest
*
Type of Employment
*
Full-Time
Part-Time
Shift Availability
*
Days
Evenings
Weekends
Holidays
Other (please explain)
Other scheduling accommodations
*
Desired Salary
*
How did you hear about us?
*
Are you legally authorized to work in the United States
*
Yes
No
Location
*
Fargo
Bismarck
Williston
Are you at least 21 years of age?
*
Yes
No
Have you ever been fired or forced to resign from a job? If yes, please explain
*
Have you ever been convicted of any felonies? If yes, please explain
*
Previous Employment
Please list your employment for at least the last seven years.
Company
*
Position
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Dates Employed
*
Email
*
Salary
*
Phone
*
Supervisor
*
Can we contact?
*
Yes
No
Reason for Leaving
*
Company
*
Position
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Dates Employed
*
Email
*
Salary
*
Phone
*
Supervisor
*
Can we contact?
*
Yes
No
Reason for Leaving
*
Please list any additional employers
*
Education
High School
School
*
Location
*
Graduated?
*
Yes
No
College
School
*
Location
*
Major/Field of Study
*
Graduated?
*
Yes
No
Professional References
Please list three professional references
Full Name
*
Email
*
Company
*
Relationship
*
Phone
*
Full Name
*
Email
*
Company
*
Relationship
*
Phone
*
Full Name
*
Email
*
Company
*
Relationship
*
Phone
*
This authorization is voluntary and is applicable only to this application for the requested information listed. A photocopy of this authorization is as effective as the original. Unless otherwise agreed to in writing, information may be disclosed under this authorization in any form or medium, including oral, written, or electronic transmission.
The information I am presenting in this application is complete, true, and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omissions could result in the denial of my application, withdrawal of any offer of employment, immediate discharge.
Pure Dakota Health is an equal opportunity employer. We operate under the principal of equal treatment for all employees and applicants without regard to race, color, creed, religion, national origin, gender, age, sexual orientation, gender identity, genetic information, marital status, disability, military or veteran status, public assistance and needs or any other basis prohibited by applicable federal, state, or local law.
Submit Application
Do I Qualify
Qualifying Criteria
Registration Process
Who is a Health Care Provider
Health Benefits
About Us
Careers
Contact Us
FAQ
Available Products
