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Job Shadowing

Job Shadowing Application

* Required

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:

Which healthcare career are you considering?:

School Name:

School Status/Year:

School Contact Reference:

List specific dates (Mon-Fri from 7:00 to 11:00 a.m.) that you are available to shadow.
Remember to allow at least 2 weeks for us to coordinate your shadowing opportunity.

Division you would like to shadow:
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 (College Sophomore minimum requirement)
Nurse Anesthetists
Surgery Tech
Emergency Room
Special Care Nursery

Therapy Services
Physical IP
Physical OP
Occupational IP
Occupational OP

Radiology (XR or US Techs)
Sleep Medicine
Vascular Lab
Hyperbaric Medicine
Cardiology Services
Pharmacy (College Freshman minimum requirement)