Proud to be Physician Owned and Operated
910 E 20th Street |
Sioux Falls, SD 57105
If hired, you will be required to submit documents sufficient to establish employment authorization and identity in compliance with
the Immigration Reform and Control Act of 1986. While you need not provide this proof of citizenship or immigration status at the
time you are interviewed, please be prepared to assure us that you can do so immediately upon being hired.
List in chronological order all positions (full‐time, part‐time and temporary) held. Start with your present or last position and work
back. You may include military service assignments and volunteer activities, if you feel comfortable doing so. Exclude organization
names which indicate, for example, race, color, religion, sex, age, disability or national origin.
List three professional references who are not related to you and are not previous supervisors.
I certify that the information given by me in this application is true in all respects, and I agree that any misrepresentation by me in this application will be sufficient cause for denial of employment or termination of employment if I am hereafter employed by Sioux Falls Specialty Hospital, LLP (SFSH).
In consideration of my employment, I agree to conform to the policies and procedures of SFSH and that SFSH may revise policies or procedures, in whole or
in part, at any time. I understand that nothing contained in this employment application or in granting of an interview is intended to create an employment
contract between SFSH and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me,
and I understand that no such promise or guarantee is binding upon SFSH. Furthermore, if I am hired, I understand that my employment will be at the will of
both parties and I am free to resign at any time for any reason, and that SFSH reserves the right to terminate my employment at any time for any reason,
with or without cause, and without prior notice. I understand that no representative of SFSH has authority to make any representations or assurances to the
It is SFSH policy to provide a safe and healthy work environment. I understand that I will be requested to submit to a urine‐based cotinine test to detect the
presence of all forms of nicotine. I understand that if an offer of employment is made and I, the applicant, test positive for nicotine, the offer of
employment may be withdrawn. I further understand that I have the right to refuse to submit to such tests of my own free will, but that such refusal may be
considered a withdrawal of my application for employment.
In accordance with the Drug‐Free Workplace Act of 1988, SFSH has established a Drug‐Free Workplace company‐wide policy. It is SFSH policy to maintain a
work environment that is safe for all employees and conducive to attaining high work standards. Therefore, if an offer of employment is made, hiring is
contingent upon me, the applicant, passing a urine drug test. I understand that I will be requested to submit to a test to detect the current illegal use of
drugs and, if the test results identify that I am a current illegal user of drugs, I will not be eligible for employment by SFSH. I further understand that I have the right to refuse to submit to such tests of my own free will, but that such refusal may be considered a withdrawal of my application for employment.
I understand any offer of employment will be contingent upon receipt of satisfactory information from background and reference checks, including
information that may be included on a consumer report about me. I authorize SFSH to make a thorough investigation of my past employment, education,
credit history, criminal records and job‐related activities. To the extent permitted by law, I release SFSH from any liability which might result from making
such investigation and I also release from any liability all persons and entities supplying such information. I understand that SFSH may obtain a Consumer
Report / Investigative Consumer Report for the purpose of evaluating me for employment, promotion, reassignment, or retention. I understand that I am
entitled to obtain, by written request, disclosure of the nature and scope of the report.
I understand that if SFSH makes an offer of employment to me it will be a conditional offer of employment and I will be requested to submit to a preemployment
physical examination and screening and to provide information in response to medical inquiries, the results of which might disqualify me from
employment. If requested, I agree to furnish such information and to submit to such pre‐employment physical examination and screening. I further
understand that I have the right to refuse to submit to such examination and screening of my own free will but that such refusal may be considered a
withdrawal of my application for employment.
SFSH is an equal opportunity and affirmative action employer and SFSH does not discriminate based on any protected class, including race, color, gender,
national origin, religion, age, marital status, sexual orientation, citizenship status, genetic information, disability, or veteran status. No question on this
application is used for the purpose of limiting or excluding SFSH’s consideration of me for employment on a basis prohibited by federal, state or local law,
nor is it used by SFSH for the purpose of attempting to obtain information prohibited by federal, state or local law.
I understand that SFSH will consider this application active for only sixty (60) days. I understand it will be necessary for me to complete a new application to be considered for future open, advertised positions.