Crittenden Community Hospital : Student Shadowing Application

Student Shadowing Application
Job Shadowing at Crittenden Community Hospital provides unpaid learning opportunities to help individuals learn about healthcare career options and skills in specific occupations. Participants have the opportunity to experience the workplace setting as well as the duties performed by the healthcare professional they are shadowing; participants are not permitted to perform work of any kind, including patient care. Shadowing experience is usually one - two days in length.
Students must attend a school affiliated with the hospital. The Chief Nursing Officer will verify this information when you submit your request. The following materials are due a minimum of one week prior to your scheduled Shadowing date: • Copy of Immunizations (MMR, Varicella, Hepatitis B) • Recent TB Skin Test (current year) or TB Questionnaire • If TB Skin Test needed, must obtain at local Health Department or Personal Care Provider • Flu Vaccine or Declination during the current flu season(October thru March) • Copy of Driverï¿½s License or Student Photo ID card Upon arrival for Shadowing the student will be required to complete a Human Resource packet that will include a Confidentiality Agreement and other required documents.
*	Full Name First and Last Name
*	Address Street
*	City, State
*	Zip Code
*	Telephone (Daytime)
*	Telephone (Evening)
*	Email
*	School
*	Grade Level
*	Birthdate
	First Area of Interest Please select your first choice of shadowing.
	Business	Accounting Human Resources Payroll Admitting
	Nursing	Med Surg Emergency Room Surgery Home Health Cardiac Rehab Infection Control/Employee Health Quality
	Rehabilitation Services	Physical Therapy Occupational Therapy
	Informatics
	Food Services
	Diagnostic Imaging	CT Scan Mammography Ultrasound
	Health Information Management / Medical Records	Transcription Coder
	Laboratory	Chemistry Blood Bank/Microbiology
	Materials Management	Purchasing Inventory Control
	Pharmacy	Pharmacist Technician
	Clerical
	Second Area of Interest Please select your second choice for shadowing
	Business	Accounting Human Resources Payroll Admitting
	Nursing	Med-Surg Emergency Room Surgery Home Health Cardiac Rehab Infection Control/Employee Health
	Rehabilitation Services	Physical Therapy Occupational Therapy
	Informatics
	Food Services
	Diagnostic Imaging	CT Scan Mammography Ultrasound
	Health Information Management / Medical Records	Transcription Coder
	Laboratory	Chemistry Blood Bank/Microbiology
	Materials Management	Purchasing Inventory Control
	Pharmacy	Pharmacist Technician
	Clerical
*	Date Available
	Comments

Student Shadowing Application

Job Shadowing at Crittenden Community Hospital provides unpaid learning opportunities to help individuals learn about healthcare career options and skills in specific occupations. Participants have the opportunity to experience the workplace setting as well as the duties performed by the healthcare professional they are shadowing; participants are not permitted to perform work of any kind, including patient care. Shadowing experience is usually one - two days in length.

Students must attend a school affiliated with the hospital. The Chief Nursing Officer will verify this information when you submit your request.
The following materials are due a minimum of one week prior to your scheduled Shadowing date:
• Copy of Immunizations (MMR, Varicella, Hepatitis B)
• Recent TB Skin Test (current year) or TB Questionnaire
• If TB Skin Test needed, must obtain at local Health Department or Personal Care Provider
• Flu Vaccine or Declination during the current flu season(October thru March)
• Copy of Driverï¿½s License or Student Photo ID card
Upon arrival for Shadowing the student will be required to complete a Human Resource packet that will include a Confidentiality Agreement and other required documents.

Full Name
First and Last Name

Address
Street

City, State

Zip Code

Telephone
(Daytime)

Telephone
(Evening)

School

Grade Level

Birthdate

First Area of Interest
Please select your first choice of shadowing.

Business

Nursing

Rehabilitation Services

Informatics

Food Services

Diagnostic Imaging

Health Information Management / Medical Records

Laboratory

Materials Management

Pharmacy

Clerical

Second Area of Interest
Please select your second choice for shadowing