St. Luke's Hospital
Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
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Job Shadowing Application

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First Name: *
Last Name: *
Phone Number: ( ) - - *
Parent/Guardian contact number (if applicable): ( ) - -
E-mail Address: *
Verify E-mail Address: *
Are you 18 or older?: *
Are you a nursing student?: *
  If you answered Yes to the above question:
Graduation Date:
Name of School:
Are you considering a 2nd career in Healthcare?: *
School Name: *
School Status/Year: *
School Contact Reference: *
Dates and Times You Can Shadow: *
 
Division you would like to shadow:
Nursing
6500 (Med/Surg ICU)
6600 (Telemetry)
6700 (Cardiovascular/Pulmonary Stepdown)
7600 (Med/Surg/Renal)
7700 (Oncology)
 8600 (Orthopedics)
8700 (Surgical)
9600 (Neuroscience)
9700 (Med/Surg/Pulmonary)
CVICU (Surgical/Cardiovascular ICU)
 Labor and Delivery
Operating Room
Mother/Baby
Emergency Room
Special Care Nursery
Therapy Services
Physical
Speech
 Respiratory
 Occupational
Other
Radiology
Laboratory
Sleep Medicine
 Vascular Lab
Social Services
Hyperbaric Medicine
 Cardiology Services
Pharmacy
 
Are you interested in shadowing in a department not listed above?:
If you answered Yes above, please explain:
 
 
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St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
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