Online Job Application

Why register?   Registering on our website is not required to complete an online job application. However, as a registered user, you can store your profile information to be used each time you apply for a job. 

After logging in, click on your user name at the foot of the page and choose Edit Profile. Select the Manage Profile tab to enter your personal information. The information you enter will automatically fill the corresponding fields in the application below. 



Position Information:

Job Title:
Have you applied at SPH before?

Personal Data:

Last Name: First: Middle:
Email:
Street Address:
City: State: Zip:
Telephone:
Alternate Telephone: Are you at least 18 years of age?
Have you been employed at SPH before? if yes, from: to:
If yes, Job Title:
Does an immediate family member or a person with whom you have a significant personal relationship work here? (Sauk Prairie Healthcare policy prohibits direct or indirect supervision of an employee by a person with such a relationship.)
Do you have the legal right to work and remain in the United States? (Employment eligibility verification is required if hired)
Have you ever been convicted of any law violation other than minor traffic violations? You must include all felonies and misdemeanor convictions including, but not limited to, disorderly conduct convictions or other non-criminal convictions which resulted in a fine. (A criminal records check will be conducted on all new employees prior to the first day of employment.)
If yes, please describe and indicate date(s). (A conviction record will not necessarily disqualify you from employment consideration. A background check is required prior to employment.)

Availability:

Check all that apply.








Are you able to rotate shifts?
Hospital employees occasionally work more than 8 hours per day and most positions work some holidays. Are you able to meet this requirement?

Education:

  Name of School Address, City, State Course of Study Last Year Completed Did you Graduate Diploma or Degree
High School
College
Technical/Business
Graduate
Other
List your experience with computers and other office equipment:
Please list any additional experiences, skills and qualifications which relate to the job for which you are applying:

Professional Licenses, Accreditations, and/or Certification:

List professional licenses, certifications, or registrations below.
License(Title): Expiration Date:
License(Title): Expiration Date:
CPR Certification? ACLS Certification?

Work History:

List all current and prior employment. A resume is not a substitute for completing this section.
Current or Most Recent Employer Company Name:
Dates of Employment:
From: To:
Street Address:
City:
State:
Zip:
Phone:
Title:

Last Salary:
Supervisor's Name:
Job Responsibilities:
Reason for Leaving:
May we contact for a reference?
Your Name Then (if different)
Previous Employer Company Name:
Dates of Employment:
From: To:
Street Address:
City:
State:
Zip:
Phone:
Title:

Last Salary:
Supervisor's Name:
Job Responsibilities:
Reason for Leaving:
May we contact for a reference?
Your Name Then (if different)
Previous Employer Company Name:
Dates of Employment:
From: To:
Street Address:
City:
State:
Zip:
Phone:
Title:

Last Salary:
Supervisor's Name:
Job Responsibilities:
Reason for Leaving:
May we contact for a reference?
Your Name Then (if different)
Previous Employer Company Name:
Dates of Employment:
From: To:
Street Address:
City:
State:
Zip:
Phone:
Title:

Last Salary:
Supervisor's Name:
Job Responsibilities:
Reason for Leaving:
May we contact for a reference?
Your Name Then (if different)

Professional References:

(Examples: Current and former supervisors, professional colleagues, professors. Do not list relatives or friends.)
Name Address Phone Email Occupation

Non-Discrimination

It is the policy of Sauk Prairie Healthcare to consider all applicants for employment without regard to age, race, color, creed, religion, disability, marital status, gender, sexual orientation, national origin, ancestry, arrest record, conviction record, veteran’s status, membership in the National Guard, state defense force or any other reserve component of he military forces of the United States or Wisconsin, or any other unlawful basis.

Service Excellence Standards

Applicant’s Consent & Authorization

I certify that the facts set forth in this application are true, correct and complete without misrepresentations or omissions of any kind whatsoever. I authorize investigation of the statements I have made in this application.

I am applying for employment with Sauk Prairie Healthcare (SPH). I hereby authorize and release from liability any and all persons (including any and all employers with whom I have been employed, schools that I have attended and organizations with which I have been connected) to release any and all information they have about me to Sauk Prairie Healthcare. This includes all of my personnel records with prior employers and any information about my performance during my employment with them and also includes all of my transcripts from any schools that I have attended. I hereby release all persons, companies, schools, and organizations (and all persons connected with them) who provide such information to Sauk Prairie Healthcare from any and all liability for any damage for giving this information.

This Authorization shall remain in effect for a period of one (1) year from the date which I sign it. A photocopy of this authorization may be used by Sauk Prairie Healthcare and shall be effective as the original. I understand that if any of the information I have provided is false or misleading or if there are any misrepresentations or omissions of any kind whatsoever, then Sauk Prairie Healthcare may deny me employment or terminate my employment, and I agree that Sauk Prairie Healthcare shall not be liable in any respect if it does so.

I also understand that my employment at Sauk Prairie Healthcare is contingent upon the satisfactory completion of a medical examination which may include drug and alcohol screens, an investigation of my work record and references, and a caregiver background check. I consent to a pre-employment medical examination and such future examinations as may be required by Sauk Prairie Healthcare, which may include drug and alcohol screens as required.

I understand that if I am employed by Sauk Prairie Healthcare, any such employment is not binding on either party for any specific period of time. I further understand that no representative of Sauk Prairie Healthcare, other that the Chief Executive Officer, has the authority to enter into any agreement of employment for any specified period of time. Any such agreement must be in writing and signed by the CEO. I understand that any other written or oral statement to the contrary, even if made by a supervisor, manager, or director of Sauk Prairie Healthcare is invalid and should not be relied upon. I understand that if employed I will be an employee-at-will and that either Sauk Prairie Healthcare or I may terminate that employment relationship at any time, for any reason, with or without notice.

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Information provided will be used for administrative purposes only.

Sex:
Race/Ethnicity:


Veteran Status:
Disability Status:
My typed name below shall have the same force and effect as my written signature.
Candidate's/Applicant's Signature:*
Date:*
Sauk Prairie Healthcare is proud to be an equal opportunity employer.
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