South Dakota Urban Indian Health


Become a partner in SDUIH's Mission

South Dakota Urban Indian Health
711 North Lake Ave.
Sioux Falls, SD 57104
605-339-0420, ext 219

Non-Discrimination Policy: In order to provide equal employment and advancement opportunities to all individuals, employment decisions at SDUIH will be based on merit, qualifications and abilities. SDUIH does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law.

Referral Source

If under 18, can you provide a work permit?
If hired, would you have transportation to/from work?
Have you ever filed an application here before?
Have you ever been employed here before?
Do you have any friends, relatives, or acquaintances working for SDUIH?
Are you currently employed?
If yes, may we conact your employer?
If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?
Employment desired:
Can you travel if a job requires it?
Can you work on the weekends?
Can you work evenings?

In accordance to IHS policy and Federal guidelines, preference will be given qualified Indian applicants in accordance to Section 703(i) of the Title VII of the Civil Rights Act of 1964. SDUIH is an Equal Opportunity Employer.

Must be able to provide Indian Preference documentation if claimed.

All employees effective from July 27, 1997 shall be required to complete a background check that will be investigated by the FBI. This is to determine if any employee has been arrested and convicted of an offense in regard to the above Public Law.

This is to determine if any employee has been arrested and convicted of an offense in regard to the above Public Law.

Should such an incident be found during the employment background check, said application will be withdrawn from consideration

Have you ever been convicted of a felony?
If yes, please explain:

Have you ever been convicted of a crime other than a minor traffic violation? Applicant is not obligated to disclose sealed or expunged records of conviction. (Answering yes to this question does not automatically disqualify you for employment; however, the severity, recentness, and relevance of the offense will be considered in the employment review process).

Convicted means you were declared guilty by a judge or jury or you pleaded quilty or no contest in court. A conviction may have even taken place if you did not pay a fine or spend time in jail or in prison. A conviction could have been for either a mmisdemeanor or a felony. A minor traffic violation is an infraction for whichyou would be ticketed. Driving while under the influence, driving on a suspended license, reckless driving, leaving the scene of an accident and vehicular homicides are not minor traffic violations.

If yes, it is mandatory that you complete this section. List each offense and provide the following: date of the offense, the charge filed, city, state, disposition of the offense, and date of disposition (i.e. pled no contest, pled guilty).
Are any criminal charges now pending against you, or have been placed on deferred adjudication?
If yes, please explain:
Have you ever been discharged or requested to resign from a position?
If yes, give circumstances:
Type of School Name of School Location Number of Years Completed Major & Degree
High School
Graduate School
Bus. or Trade School
Professional School
COMPUTER SKILLS (Only for positions which require computer use)

Check off those computer skills with which you are proficient (any version).

DRIVER’S LICENSE (Only for positions which require driving)
Do you have a driver's license?
Have you had any accidents during the past three years?
Have you had any moving violations during the past three years?

Please list other special skills you may have, e.g. licenses, special training required for the position for which you are applying, etc.
Please list your work experience beginning with your most recent job. If you were self-employed, give firm name. Attach additional sheets if necessary. Exclude organization names which indicate race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law.
Dates Employed

Dates Employed

Dates Employed

Are you a veteran of the United States military service?

If yes, please describe any special skills or training acquired while in the service:
Please list three professional references that you have worked with and can attest to your work performance. Please do no list relatives or employers who are listed above.



It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired; my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization.


I certify that the information in this application is true, complete and correct. I understand that false answers, statements, or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge.


I understand that employment is subject to a background check, and hereby authorize South Dakota Urban Indian Health to investigate my background to determine any and all information of concern as to my record, whether same is of record or not, and I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information.

Additionally, you are hereby authorized to make any investigation of my personal history, educational background, motor vehicle records, and criminal records through an investigative or credit agency or bureau of your choice. I authorize the release of this information by the appropriate agencies to the investigating service. This authorization, in original or copy form, shall be valid for this and for any future reports and updates that may be required.

I understand that passing the background check is a condition of employment. A negative background check may not necessarily disbar me from employment. However, certain violations can be grounds for dismissal, even if an offer has been made to me and I have been hired.