Name: Lakeside Health
Address: St. Cloud, MN
Telephone: (320) 406-4040

Online Job Application Form

LAKESIDE Health Services, Inc. Application for Employment

Step 1 of 5

EMPLOYMENT DESIRED
Position Applied For
Position Type
Type of Employment Desired
- Full Time
- Part Time
- Seasonal/Temporary
Date Available
Date Format: MM slash DD slash YYYY
How did you hear about us?
Ad Name
Please tell us where you heard about us:

PERSONAL INFORMATION
First Name*
M.I.
Last Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email Address*
Are you legally eligible to hold employment in the U.S.?
Are you eighteen years of age or older?
If under 18, please state date of birth:
Date Format: MM slash DD slash YYYY
Do you have any special needs which may necessitate accommodations in the applicant/interview process?

EMPLOYMENT HISTORY
Employer #1
Employer Name
Employer Phone
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Employer Address
Street Address City State / Province / Region ZIP / Postal Code
Supervisor's name and title
Hours per week
Salary Start
Salary Final
May we contact your present employer?
If you answered no, please tell us why?
Description of duties
Employer #2
Employer Name
Employer Phone
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Employer Address
Street Address City State / Province / Region ZIP / Postal Code
Supervisor's name and title
Hours per week
Salary Start
Salary Final
May we contact your present employer?
If you answered no, please tell us why?
Description of duties
Employer #3
Employer Name
Employer Phone
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Employer Address
Street Address City State / Province / Region ZIP / Postal Code
Supervisor's name and title
Hours per week
Salary Start
Salary Final
May we contact your present employer?
If you answered no, please tell us why?
Description of duties
Upload a PDF or DOC file of your most current resumé below
Attach a resumé

EDUCATION
Did you graduate from high school?
If you graduated from a secondary or post-secondary school, what degree do you have and in what field?
Please list any relevant professional licenses or certifications (including Driver's License)
VOLUNTEER EXPERIENCE OR UNPAID WORK EXPERIENCE
Name of organization
Work performed
Hours per week
From
To
Name of organization
Work performed
Hours per week
From
To
Name of organization
Work performed
Hours per week
From
To
SKILLS, TRAINING & ADDITIONAL EXPERIENCE
Describe any skills, abilities, training or other experiences that will help you in this position
REFERENCES
LAKESIDE Health Services, Inc. requires that all applicants must submit three references, which may include, current or former employers, supervisors, teachers or others qualified to objectively evaluate your ability to work in the position for which you have applied. Please list the reference information listed below. LAKESIDE Health Services, Inc. will be contacting each reference listed.
Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email
Title
Relationship
Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email
Title
Relationship
Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email
Title
Relationship

Digital Signature
Thank you for your interest in Lakeside Health Services, Inc. We at LAKESIDE Health Services, Inc. are pleased you are interested in becoming a member of our company. We are proud of our excellent reputation and the services we provide. We value diversity and want your work experience to be enjoyable. To help ensure a safe work environment and excellent services we carefully screen the background of all applicants. This screening may include an oral interview, as well as an investigation of your work history, driving record, application information, and reference check. LAKESIDE Health Services, Inc. requires that an investigation of your background for any criminal conduct be completed upon conditional hire and annually thereafter. Some service areas may also require a screening for the use of illegal drugs.
APPLICANT DECLARATION OF UNDERSTANDING:
- I understand that LAKESIDE Health Services, Inc. may conduct an investigation of the information I have noted on this application and, as part of that investigation, may contact prior employers and references, among others. I authorize LAKESIDE Health Services, Inc. To conduct this investigation and I release from all liability and hold harmless any person giving or receiving information about me relative to this investigation.
- I understand that any falsification, misrepresentation or omission of information discovered as a result of this investigation may prevent my being hired or if hired, may subject me to the immediate termination of my employment with LAKESIDE Health Services, Inc.
- In understand that this application process does not create an employment contract.
- I understand all employment at LAKESIDE Health Services, Inc. is “at will.” This means, if LAKESIDE Health Services, Inc. employs me, my employment is not for a specified or definite period of time and that I may resign or be discharged from my position at any time, for any reason, with or without cause or prior notice. I understand that the “at will” policy listed above cannot be changed or amended without a formal written employment agreement signed by me and by a member of the Board of Directors of LAKESIDE Health Services, Inc.
- I declare that I have never committee nor been charged or convicted of any act of abuse, neglect, exploitation or fraud in relationship to a dependent/vulnerable child or adult within the past 10 years.
- I declare that I have never knowingly violated any applicable rules or laws in any previous employment in a residential, healthcare or similarly related employment.
Signature
By signing below, I agree that I have read and understand the declarations listed above and I assert that all information given in this application is true.
Today's Date
Date Format: MM slash DD slash YYYY
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Online Job Application Form

Step 1 of 5

EMPLOYMENT DESIRED

PERSONAL INFORMATION

EMPLOYMENT HISTORY

Employer #1

Employer #2

Employer #3

Upload a PDF or DOC file of your most current resumé below

EDUCATION

VOLUNTEER EXPERIENCE OR UNPAID WORK EXPERIENCE

SKILLS, TRAINING & ADDITIONAL EXPERIENCE

REFERENCES

Digital Signature

APPLICANT DECLARATION OF UNDERSTANDING: