Employment Application

Please read all instructions carefully and complete all sections of the application accurately.
  • Attention applicant:

    Dakota Eye Institute is an equal opportunity employer in recruitment, interviewing, hiring and employment practices. All applicants' job experiences, education, training, and other qualifications will be considered without discrimination on the grounds of race, color, religion, sex, age, national origin or disability. The information which is provided by you in this application will be treated confidentially and will be used only to help assure the best use of your abilities in the event you become employed by Dakota Eye Institute. It is your responsibility to provide sufficient information on this application to indicate that you meet the minimum qualifications for the job for which you wish to be considered. In compliance with the Americans with Disabilities Act(ADA), Dakota Eye Institute will prove, if requested, reasonable accommodation to applications in need of accommodation in order to provide access to the application, interviewing and selection process. If you require reasonable accommodations to complete this employment application please feel free to notify us.
  • Employment History

  • Education

  • Post Secondary Education

    (Official transcripts may be required for persons selected for employment)
  • License(s)

    List all relevant certificates or licenses (including valid driver's license)
  • General Information

  • Description of offense:
  • Professional References

    Please list up to three(3) current references who are familiar with your work-related abilities and background. Do not list relatives.
  • Please list any additional acquired skills, knowledge or experience you would like considered in assessing your qualification for this position(such as volunteer work, vocational training, computer course, software programming, office skills, foreign language skills, keyboarding skills/speed, research skills, computer skills, etc.)
  • Signature

    I hereby certify that all information is true and complete to the best of my knowledge. I understand that employment in certain positions may be conditional upon a review of criminal records. I authorize Dakota Eye Institute to request and obtain records to determine the accuracy of my response. I agree to abide by all applicable rules, regulations and policies upon my acceptance of employment with Dakota Eye Institute. I understand that any material misrepresentation or omission on this application may be grounds for rejection of my application or termination of any subsequent employment with Dakota Eye Institute. I understand that if I am employed by Dakota Eye Institute, such employment will be for an indefinite period of time, an dthat either I or Dakota Eye Institute can terminate such employment at any time. I further understand that Dakota Eye Institute can change wages, benefits and conditions of employment at any time.
  • Thank you for your interest in applying for employment with Dakota Eye Institute.