PRAIRIE VIEW, INC., Human Resources Department, P. O. Box 467, Newton, Kansas 67114-0467 - (316) 284-6311
ONLINE EMPLOYMENT APPLICATION
Last Name
First Name
Middle Initial
 
Address
City
 
    
State
Zip
E-mail Address
Phone
County
Position Desired
Do you have a legal right to accept employment in the United States?
 Yes No Do you agree to take a physical examination if re-quested after employment? Yes No
Have you been previous been employed at Prairie View?
Yes No  
If yes what was your name?
 Are you at least 18 years of age? Yes No
When were you employed at Prairie View?
  
Are you related to anyone employed at Prairie View?
 Yes No Clinicians and Nurses: [Clinicians please email us your resume]
If so, who and how?
License No.
State:

EDUCATION
Name & Location of Schools/Colleges Major Subjects Did you graduate? College Degree Period of Attendance
From To
Yes No
Yes No
Yes No
Yes No

FORMER EMPLOYERS AND EXPERIENCE (Most Recent First)
Name & Address
Job Title
Period of Attendance
Cash Salary
Other Compensation
Reason for Leaving
From To

WORK-RELATED REFERENCES
Name
Address
Phone & Email
Work
Home
 Email Addr

 
Other special training or skills
Reason for desiring change of employment
What prompted you to apply here for employment?
I am interested in
Full Time     Part Time     Contract     PRN & Seasonal
Have you ever been convicted of a felony?*
Yes No
If yes , describe in detail
*A conviction record will not necessarily be a bar to employment, and factors such as age and time of the offense,
the seriousness and nature of the violation, and the applicant's rehabilitation will be considered in the hiring decision.


PLEASE READ CAREFULLY BEFORE SUBMITTING:

(1) I certify that the information contained in this application is correct and complete to the best of my knowledge and understand that omission, misrepresentation, or falsification of information is grounds for refusal to employ me or my dismissal if I am employed. (2) I authorize the schools, current and past employers, and references listed above to give Prairie View any and all information concerning my previous employment and any information they may have, personal or otherwise, and release all parties from all liability for any damage or claim that may result from furnishing the same to Prairie View. (3) I understand that an investigative report may be made whereby information is obtained through the Kansas Bureau of Investigation (KBI), SRS Child Abuse Registry, SRS Adult Protective Services, and Department of Motor Vehicles. You have the right to make a written request within a reasonable period of time for a complete and accurate disclosure. (4) If I am employed, I agree to abide by the rules, regulations, and policies of Prairie View, and that my employment and compensation can be terminated with or without notice at any time at the option of either Prairie View or myself. (5) I understand that Prairie View is a tobacco-free facility, and tobacco products will not be permitted anywhere on the property, including staff and Prairie View vehicles.

Persons currently or previously in therapy or with immediate family members currently or previously in therapy at Prairie View are eligible to be employed provided they will not be working in a position within the same administrative or clinical supervisory area or work group/area as the involved therapist(s).

As an equal opportunity employer, Prairie View will not discriminate unlawfully against any employee or applicant for employment because of race, color, religion, national origin, gender, age, ancestry, physical or mental disability, or other factors, if any, which are protected by valid, applicable laws.

 

In submitting this application for employment to you (Prairie View), I clearly understand and agree to the above terms.

Yes No

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