DACOTAH FOUNDATION EMPLOYMENT APPLICATION
600 South 2nd Street, Suite 308, Bismarck, ND 58504or1411 South 32nd Street, Suite 3, Fargo, ND 58103
Personal Information
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the best time to contact you?
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Morning
Lunch Time
Evening
Afternoon
Doesn't Matter
If applicable, please detail any restrictions:
Are you currently legally entitled to work in the country where the job is based?
Yes
No
Please disclose any convictions or traffic violations relevant to your application.
If selected for employment are you willing to submit a background check?
Yes
No
Position Information
What position are you applying for?
Please Select
Administrative Assistant
Mental Health Tech
Medication Monitor
Representative Payee
Residential Aide
Peer Support Specialist
Program Coordinator
Assistant Supervisor
Nursing
Program Supervisor
Program Director
Program Administrator
Chief Operations Officer
Other
What is your desired employment?
Please Select
Full Time
Part Time
Internship
What is your desired pay?
Monthly
What is your available start date?
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Month
-
Day
Year
Date
Have you worked for Company before?
Yes
No
Please provide your department, manager, the time period you have worked for Company and reason of leave
Education
Work Experience
Starting with your most current employment please list at least three previous employers
Qualifications
Microsoft Office
1
2
3
4
5
Communication Skills
1
2
3
4
5
Please upload your CV here.
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Date
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Month
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Day
Year
Date
Signature
Equal Opportunity Employer
Equal Opportunity Employer: Dacotah Foundation does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services and complies with the provisions of the ND Human Rights Act.
References
Reference 1 - Name
*
First Name
Last Name
Reference 1 - Relationship
*
Family
Friend
Manager
Colleague
Client
Other
Reference 1 - Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 1 - Email Address
*
example@example.com
Reference 2 - Name
*
First Name
Last Name
Reference 2 - Relationship
*
Family
Friend
Manager
Colleague
Client
Other
Reference 2 - Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 2 - Email Address
*
example@example.com
Reference 3 - Name
*
First Name
Last Name
Reference 3 - Relationship
*
Family
Friend
Manager
Colleague
Client
Other
Reference 3 - Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference 3 - Email Address
*
example@example.com
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