Employment application

Dakota Travel Nurse is an equal opportunity employer. It is our policy to comply with all applicable local, state and federal laws prohibiting discrimination in employment based on protected class status such as race, age, color, sex, religion, national origin, marital status, familial status, sexual orientation, genetic information, disability and all other protected classes under law.  

Consumer and/or investigative consumer report disclosure and authorization

In considering your application for employment or in making other employment decisions, Dakota Travel Nurse, Inc. (Dakota Travel Nurse) may request that a consumer reporting agency prepare consumer reports or investigative consumer reports (“investigative reports”) regarding you. In addition, investigative reports and/or background checks may include, but not limited to, information regarding your criminal history, employment history, education, medical and processional licensing, training, motor vehicle records, references and credit history.  If an investigative report is conducted, the report may include information obtained through personal interview regarding your character, general reputation and personal characteristics, or mode of living. You are entitled to obtain, by written request, disclosure of the nature and scope of the report.

By signing this document, you consent to Dakota Travel Nurse obtaining one or more consumer reports and/or investigative consumer reports on you and further consent Dakota Travel Nurse independently conducting one or more background checks on you. Such reports or checks may be obtained or conducted in connection with your application for employment and from time to time thereafter during your employment with Dakota Travel Nurse. Your failure or refusal to consent may be considered by Dakota Travel Nurse in evaluation your application for employment or in making other employment discussions during your employment with Dakota Travel Nurse.

I hereby consent and authorize Dakota Travel Nurse to obtain consumer reports and or consumer investigative reports and/or conduct background checks on me from time to time for the purposes of making hiring and other employment decisions about me. I acknowledge that I have read this entire document and understand the same. This consent and authorization shall be effective unless I expressly revoke in writing and send such revocation to Dakota Travel Nurse.

Signature for consumer and/or investigative consumer report disclosure and authorization *

Personal Data

If offered employment, can you provide documentation to verify your identity and legal authority to work in the United States? *

Position Applying For

Days Available
Hours Available
Have you ever worked for Dakota Travel Nurse?

Education and Training

List all high schools, business or trade schools, colleges and universities attended, starting with the most recent. 

Employment Record

Current/Most Recent
Reason for Leaving (mark one and explain)

First Previous
Reason for Leaving (mark one and explain)

Second Previous
Reason for Leaving (mark one and explain)

Professional References

Important - Read Before Signing

I understand that if I am selected for an interview or given a conditional offer of employment, Dakota Travel Nurse, Inc. (the “company”) may ask me if I have been convicted of a misdemeanor, a felony or convicted in a military court martial and, if yes, ask me to provide information regarding the same. I understand the Company may consider this information in connection with deciding whether to hire me in accordance with applicable law.

I authorize the Company to investigate the information contained in this application and release it (and its employees and agents) from any and all liability for seeking information opinions on me. I authorize all employees, educational institutions and persons listed on this application or identified during the hiring process to provide information about me and hereby release them from all liability for providing such information. I hereby waive any privilege I have to such information.

I certify that the information I provide the Company in this application and during the hiring process is true and complete. I understand and acknowledge that any false, misleading or incomplete information in the application or during the hiring process may result in rejection of my application or, if I have been hired, immediate termination of employment.

I understand that nothing contained in this employment application or in the granting of an interview, and nothing in the Company’s polices, procedures, or handbooks that I might receive if I am hired, is intended to create an employment contract between the Company and me for either employment or 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 the Company unless made in writing and signed by an authorized office or the Company.

If an employment relationship is established, I understand that it will be an “at-will” relationship and that I will have the right to terminate my employment at any time, with or without cause, and that the Company retains the same right with regard to ending my employment. Provided, however, that I may enter into an employment contract for a specific term of dates at a specific site, in which case the terms of employment are governed by the contract.  I also understand that I may be required to sign restrictive covenants to protect the Company’s business.