Project Management Nurse Application (Full-Time)

Application for Employment

Dakota Hope is an equal opportunity employer.
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Type of Employment Desired:
Are you a member of a local church?

Personal Information

Are you currently employed?
If yes, may we contact your current employer?
Can you provide documentation to establish eligibility for employment as required by the INS?
(Proof of citizenship or immigration status will be required upon employment.)
Have you been convicted of a felony within the last 7 years?
(Conviction will not necessarily disqualify applicant from employment.)

Education and Training



Employment Experience

Start with the most recent job. Include job related military service assignments and volunteer activities. (You may exclude organization names that would reveal sex, race, religion, national origin, age, ancestry, disability, or other protected status.)

Notes (additional job related information):

Please read carefully and sign the statement below. I understand and agree that: 1. The information given here in is true and complete to the best of my knowledge. Any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company. DHC Application for Employment Revised 04/23/20 Page 5 of 5 2.I authorize investigation of all statements contained in this application for employment as maybe necessary in arriving at an employment decision (including employment reference checking and background/credit check). I release my prospective employer and any person or entity providing such reference information from any and all liability relating to the provision of such information or relating to any employment decisions based upon such information. 3. This application for employment shall be considered active for a period of time not to exceed 180 days. If I wish to be considered for employment beyond this time period, I understand that I need to inquire as to whether or not applications are being accepted at that time. 4. Neither this document nor any offer of employment from the employer constitutes an employment contract unless a specific document to that effect is executed by the employer and me in writing. If I am hired, my employment will be “at will” and without fixed term and may be terminated at any time. 5. I am required to abide by all rules and regulations of the employer. I understand, also, that I must be willing and able to demonstrate commitment to the Dakota Hope Clinic purpose, mission, and vision statements, core values, statement of care and competence, and faith statement in the execution of position responsibilities. 6. Completing this form does not indicate there is an available position and does not obligate the Company to hire me.


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